Background: To evaluate the use of NMP22 BladderChek® (NMP22BC) as an initial test in comparison to voided urine cytology for screening subjects with asymptomatic microscopic hematuria (AMH); those who are <40 years of age and have a low risk for bladder cancer based on a non-smoking history, and by discussing the guidelines on this subject. Methods: From October 2005 to September 2007, 164 patients (56 male, 108 female) were evaluated. Patients with risk factors according to AUA Best Practice Policy Recommendations on AMH were strictly excluded from the study. For upper urinary tract imaging, ultrasonography (USG) was performed and prior to the cystoscopic procedure freshly voided urine was sampled for urine cytology and NMP22BC assay in all patients. Biopsy was performed if suspicious lesions were seen or positive cytology was obtained. Results: The mean age was 30.8 years. As some benign urological pathologies were detected in 21 patients by USG, NMP22BC was positive in 26 patients where the cytology was confirmed as atypia in 5. Two TaG1 tumors were detected cystoscopically in a 39-year-old man and a 33-year-old woman where the NMP22BC test was positive and the cytology was negative in both patients. NMP22BC tests sensitivity, PPV and NPV values were detected to be higher compared to cytology and the likelihood ratio was 6.75. Conclusion: We recommend in evaluation of low-risk patients with AMH that, as an initial test, two non-invasive and cost-effective methods be chosen: an upper tract imaging by USG as recommended by guidelines, followed by an NMP22BC test for lower tract investigation instead of urine cytology.

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