EMERGING ROLE OF URINARY BIOMARKERS IN DETECTION OF UROTHELIAL BLADDER CARCINOMA IN SOUTH INDIAN POPULATION

Urine cytology is used for screening of exfoliated bladder cells from voided urine but lacks sensitivity. This study aims to check the efficacy of 5-aminolevulinic acid (5- ALA) fluorescence cytology and establish a high sensitivity approach in detecting flat, in-situ and/or small lesions that are hardly visible under conventional cystoscopy. Intracellular PPIX allows red fluorescence detection. In this study, 5-ALA fluorescent cytology using urine was compared with conventional cytology in the diagnosis of bladder tumors. In this prospective study, we compared the sensitivity and specificity between conventional cytology, 5-ALA fluorescent cytology and FDA approved commercially available kits (NMP-22 and BTA). The percentage of Protoporphyrin IX facilitated by 5-ALA was amplified in cancer urothelial cells compared to normal urothelial cells. The sensitivity of conventional cytology and 5-ALA fluorescent cytology was 64% and 96% respectively, whereas the specificity was 92% and 98.67% respectively. In conclusion, 5-ALA induced fluorescent urine cytology demonstrated promising outcomes in the detection of bladder carcinoma cells. Furthermore, low grade and low stage tumor cells as well as flat lesions were also positively and accurately interpreted using 5-ALA fluorescent cytology.