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BTA Stat: A Useful or an Unnecessary Urinary Marker in the Diagnosis of Primary Bladder Cancer?

Objectives: Use of urinary bladder markers in daily practice is still under debate. Our study assessed the diagnostic yield of the BTA stat test in comparison to histology, in patients presenting with hematuria. Methods: One hundred and twenty-two consecutive patients who presented with painless macroscopic hematuria and were evaluated for primary bladder cancer from November 2006 to November 2008 were retrospectively studied. Patients with a history of bladder cancer, pelvic irradiation or malignancies were excluded from the study. Patients with obvious or suspicious lesions were treated with transurethral resection of the bladder tumor and bladder biopsy was done. The test’s specificity, sensitivity, negative predictive value, positive predictive value and sensitivity in relation to tumor macroscopic features and histology were calculated. Results: Mean age was 68.1 years. Bladder cancer was diagnosed in 34 (27.8%) patients. In 30 patients (24.5%) the cause was undefined and 58 (48.3%) had benign causes of hematuria. The test was positive in 16/34 cases with bladder cancer, 12/30 with no visible cause and 12/58 of the cases with benign causes. Sensitivity was 47% and specificity 72.7%. Positive predictive value and negative predictive value were 40 and 75.6% respectively. Sensitivity was increased for high grade, nodular and invasive lesions (66, 80 and 75%, respectively). Two patients with an initial negative diagnostic work-up were later proved to have bladder cancer. The most common cause of a false positive test was cystitis. Conclusions: BTA stat, has low sensitivity for the diagnosis of bladder cancer and is not useful for the diagnosis of bladder cancer in patients with hematuria. False positive results can be minimised if patients with known or obvious benign conditions are excluded de novo from the test.