Podcast - "Ask the Expert" - I am Getting a Positive NMP22 result but a Negative Cystoscopy. What does it Mean?I’m getting a positive NMP22 result but a negative cystoscopy. What does it mean?
There are really three different answers as to what it could mean. Certainly it is possible it could be a false positive test; it happens with NMP22 in a small percentage. It happens with any test for urinary sediment.
A second possibility is that this could be an upper tract tumor where there is nothing in the bladder, and if the patient hasn’t had a recent upper tract examination I strongly recommend that.
Third it is possible we are missing something in the bladder with our cystoscopy. Now it that could be because it is a carcinoma in situ which is very difficult to see, or it might be we just missed an obvious tumor. If you look at the study we published in JAMA on this, it was really amazing to see about 10 percent of the tumors were actually missed and only found because the NMP22 was positive and forced us to go back and reevaluated it.
I think one thing we have definitely given up a little on is using the standard flexible cystoscopes in an office setting. The lighting that we have is not what it is with the rod lens scope for example in the OR, or anyone who has tried the digital cystoscopes knows how much better that is. I think it’s possible to miss a tumor.
This is the reason I really like to know the NMP result prior to cystoscopy. If it’s positive I’m going to spend a lot more time on that cystoscopy making as sure as I possibly can that I am not missing a tumor.
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