***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To evaluate , in a prospect i ve study , the role of immunocytology in assessing patients with gross haematuria .  Due to the high prevalence of urothelial cancer in this population , a thorough assessment is m and atory to identify all patients with tumours Objective : To compare the BTA statTM test ( BTA stat ) , a new one-step immunochromatographic assay that can be performed in the urologist ’s office or in the laboratory , to voided urine cytology and bladder wash cytology ( cytology ) in the diagnosis and monitoring of cancer of the bladder ( BC ) . Methods : BTA stat and cytology were performed in a double-blinded , prospect i ve , clinical study on specimens from 240 subjects ( 68 females ; mean age of subjects : 64 years ) suspected of having BC . Results : In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy  , the overall sensitivities of BTA stat and cytology were 65 and 33 % , respectively . For tumor grade s I , II , and III , the sensitivities of BTA stat were 39 , 67 and 83 % , respectively . Those of cytology were 4 , 20 and 69 % . Nine subjects had a diagnosis of ‘ suspicious for bladder cancer ’ . The specificities of BTA stat and cytology  in the 124 subjects without BC were 64 and 99 % , respectively . In the subjects with a history of BC ( n = 74 ) , the specificities of BTA stat and cytology  were 72 and 99 % , respectively . The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC ( 46 % ) than in subjects without genitourinary disease ( 71 % ) . Conclusions : The BTA stat test  is considerably more sensitive than  cytology  in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC . However , due to low specificity , BTA stat should not be used without first ruling out potential interferences such as infections , renal disease and cancer , or genitourinary trauma PURPOSE While detecting bladder cancer , bladder tumor markers demonstrate improved sensitivity compared with urinary cytology but the current limitation is the low specificity and positive predictive value , that is high false-positive rate . We examined the clinical categories of the false-positive results , established relative exclusion criteria , and recalculated the specificity and positive predictive value of this assay with these criteria . MATERIAL S AND METHODS A total of 608 patients considered at risk for bladder cancer presented to a urology clinic and su bmi tted a single urine sample . Of the 608 patients 529 ( 87 % ) presented with de novo hematuria or chronic voiding symptoms without a diagnosis of bladder cancer . There were 79 ( 13.0 % ) patients being monitored with a known history of bladder cancer . Each urine sample was examined via cytology , urinalysis , culture and NMP22 protein assay . All patients underwent office cystoscopy , and transurethral resection and /or biopsy if a bladder tumor was suspected . RESULTS Of the 608 patients 226 ( 37.2 % ) presented with  microscopic hematuria  , 143 ( 23.5 % ) with gross hematuria and 239 ( 39.3 % ) had chronic symptoms of urinary frequency or dysuria . There were 52 ( 8.6 % ) patients who had histologically confirmed bladder cancer . Of these 52 cancers NMP22 detected 46 ( 88.5 % ) , whereas cytology identified only 16 ( 30.8 % ) . When atypical cytology was considered positive , cytology detected 32 ( 61.5 % ) cases . In the 135 patients with increased NMP22 values the 46 identified tumors were accompanied by 89 false-positive values yielding a specificity of 83.9 % and a positive predictive value of 34.1 % . These false-positive results were divided into 6 clinical categories . Exclusion of these categories improved the specificity and positive predictive value of NMP22 to 99.2 % and 92.0 % , respectively , yielding results similar to urinary cytology ( 99.8 % and 94.1 % ) . CONCLUSIONS Awareness and exclusion of the categories of false-positive results can increase the specificity and positive predictive value of NMP22 , enhancing the clinical use of this urinary tumor marker BACKGROUND Human complement factor H-related protein ( hCFHrp ) is produced by several bladder cancer cell lines and may be useful as a cancer marker . The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs , symptoms , or preliminary test results . METHODS The BTA TRAK assay , a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine , was compared with exfoliative cytology in 220 patients ( 155 men , 65 women ; mean age , 64.2 years ) presenting with signs , symptoms , or preliminary diagnostic results suggestive of this disease .  Cystoscopy was the st and ard of detection . RESULTS In the 100 patients found to have bladder cancer , the overall sensitivities of the BTA TRAK assay ( at a previously determined decision threshold of 14 kilounits/L ) and cytology were 66 % ( 66 of 100 ) and 33 % ( 33 of 100 ) , respectively ( P < 0.001 ) . The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grade s I and II and for stage Ta and T1 tumors . In contrast , the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69 % ( 83 of 120 ) and that of cytology was 99 % ( 119 of 120 ; P < 0.001 ) . The specificity of the BTA TRAK assay  was higher in patients without benign or malignant genitourinary disease other than bladder cancer ( 76 % ; n = 89 ) than in patients with these conditions . When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone , increases in overall sensitivity and equivalent specificity were observed . CONCLUSION Because of its relatively high sensitivity , the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer PURPOSE The limitations of cytology and the invasiveness of cystoscopy for detecting bladder cancer generate increasing interest in noninvasive , urine bound diagnostic tools . We assessed the diagnostic value of the newly developed immunocytochemical test , Immunocyt , which detects cellular markers specific for transitional cell cancer in the voided urine of patients with bladder cancer . MATERIAL S AND METHODS Participating in our prospect i ve study were 264 consecutive patients with a mean age of 65.9 years , including 114 in whom symptoms were suggestive of bladder cancer and 150 who were being followed after complete transurethral resection of superficial transitional cell carcinoma . Voided urine specimens were evaluated by  st and ard cytology and the Immunocyt test , which traces the monoclonal antibodies M344 , LDQ10 and 19A211 against transitional cell carcinoma in exfoliated urothelial cells . In all cases cystoscopy was subsequently performed and any suspicious lesion was evaluated by biopsy . RESULTS Histologically proved  transitional  cell carcinoma was found in 79 patients .  Immunocyt  with cytology had 89.9 % sensitivity overall ( 84 , 88 and 96.5 % in grade s 1 to 3 disease , respectively ) . A total of 34 ( 43 % ) , 3 ( 3.8 % ) and 34 ( 43 % ) cases were positive on Immunocyt only , cytology only and both evaluations , respectively . In 8 cases ( 10.1 % ) both tests were negative . Overall  Immunocyt  only was 86.1 % sensitive ( 84 , 84 and 89.6 % in grade s 1 to 3 disease , respectively ) and 79.4 % specific . Overall cytology only was 46.8 % sensitive ( 4 , 52 and 79.3 % in grade s 1 to 3 disease , respectively ) and 98.2 % specific . CONCLUSIONS Immunocyt is a noninvasive , highly sensitive test for detecting transitional cell carcinoma of all grade s and stages . When combined with conventional urinary cytology , it may replace cystoscopy in select patients , especially in followup protocol s of low grade transitional cell carcinoma PURPOSE The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma . We assess the clinical performance of ImmunoCyt ( DiagnoCure , Inc. , Saint-Foy , Canada ) in the detection of bladder cancer in a 10-center French trial . MATERIAL S AND METHODS From October 2000 to April 2001 , 694 patients undergoing cystoscopy were prospect ively included in the study . Of the patients 458 ( 66 % ) had been previously treated for superficial transitional cell carcinoma and 236 ( 34 % ) were referred for symptoms suggestive of bladder cancer . All patients underwent ImmunoCyt test and st and ard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions .  Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold st and ard and histopathology when available . RESULTS A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed . Overall sensitivity of urinary cytology was 17.9 % , 46.3 % and 63.8 % respectively , for G1 , G2 and G3 transitional cell carcinoma , whereas that of ImmunoCyt was 60.7 % , 75.6 % and 76.8 % . Sensitivity of the combined tests was 66.7 % , 78 % and 87 % , respectively . Moreover , 10 of 55 ( 18.2 % ) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone . Specificity of urinary cytology was 94.5 % , whereas that of ImmunoCyt was 84.2 % . Specificity of the combined tests was 80.7 % . Marked variations in urinary cytology sensitivity were observed among the different centers ( 27.3 % to 66.7 % ) , whereas combined assays ( urinary cytology and ImmunoCyt ) enhanced the overall sensitivity in the 80 % range at most centers . CONCLUSIONS This prospect i ve multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in st and ard urinary cytology protocol . This increased sensitivity was observed in high grade lesions ( with 100 % sensitivity for carcinoma in situ ) as well in low grade , low stage tumors BACKGROUND AND AIMS Cystoscopy and urine cytology are the st and ard tools for monitoring superficial bladder cancer . The sensitivity of cystoscopy is , however , limited to the tumours that can be visualised , and the sensitivity of cytology is relatively low in low-stage/low- grade tumours . Therefore , new tumour markers have been developed . BTA stat has been reported to have high sensitivity in detecting both primary and recurrent bladder tumours , and may have the potential to detect tumours that can not be visualised by routine cystoscopy including recurrences in upper tract . The objective of the study was to analyse the reliability of routine follow-up cystoscopy by further investigating patients with positive marker status , BTA stat Test and urine cytology , but negative cystoscopy . MATERIAL AND METHODS 446 consecutive patients being followed for bladder cancer were analysed in a prospect i ve multicenter study . A voided urine sample was obtained prior to cystoscopy and split for culture , cytology and BTA stat testing . In the case of positive marker status , BTA stat Test or urine cytology , but negative cystoscopy patients were further investigated by i.v . urography or renal ultrasound and r and om biopsies . The sensitivity of routine follow-up cystoscopy is reported . RESULTS Of 446 patients 131 ( 29.4 % ) had a bladder cancer recurrence at routine cystoscopy . Of the remaining 315 patients not having recurrent tumour at cystoscopy , 56 patients ( 17.8 % ) had positive BTA stat Test result , 6 ( 1.9 % ) had positive cytology and 5 were positive by both tests . Nine recurrences that were missed at routine follow-up cystoscopy were detected by further investigations making the total number of bladder confined recurrent tumours 140 ( 140/446 , 31.4 % ) . Five 
    Output:
    
Sensitivity and specificity of qualitative NMP22 .