THE STUDY OF TUMOUR MARKERS NMP22 AND CYTOKERATIN 20 IN BLADDER CANCER IN A TERTIARY CARE HOSPITAL
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Introduction and Aim: Bladder tumours cases are expected to rise to 79.6% in India by 2040. The life time risk for bladder tumours is 1.1 and 0.27% in males and females respectively. The detection using markers has gained the attention of the researchers recently. Nuclear matrix Protein (NMP) 22 and Cytokeratin 20 are effective markers that need to be detected and tested in bladder cancers. Materials and Methods: Study was cross sectional study conducted on 50 male subjects (TURBT and bladder biopsy diagnosed cancer patients) recruited from the OPD in a tertiary care hospital. The study was approved by the Institutional Ethics Committee. NMP22 was estimated by ELISA and Cytokeratin 20 levels were assessed by Immunohistochemistry (IHC). Cytokeratin 20 was estimated from Tissue samples of the histopathological proven bladder cancer whereas 50 pre operative samples from bladder cancer were taken to estimate NMP 22. The data was analysed using SPSS 21.0 software. Results: Out of 50 subjects 47 were males, 45 had history, 82 % had hematuria. On ultrasound , polyploidal growth was most common and 60% had size more than 3 cms and 42 % had lateral wall growth. On histopathological examination, low- and high-grade tumour had equal occurrence with 90% having urothelial papillary type of lesion and lamina propria invasion was found in 80 % of patients. Correlation was positive between invasion into detrusor muscle and lympho vascular structure whereas no significant correlation between grade, smoking and invasion into lamina propria was found. Cytokeratin 20 was positive in high grade (77.8%), low grade (93.3%) tumors, diffusely positive in 24/37 and 18/19 cases of invasion into lamina propria and detrusor muscle respectively, focally positive in eight and negative in 5 cases and the association was found to be significant. Association between the immunorectivity of cytokeratin 20 , invasion into lymhovascular structures was found to be significant. The mean values of NMP 22 in high grade, with invasion into lamina propria, detrusor muscle and lympho vascular structure were found to be 17.74 U/ml, 16.15 U/ml, 18.04 U /ml and 17.75 U /ml respectively. The association of NMP 22 with high grade tumors, invasion into detrusor muscle and lympho vascular structure were found to be significant. The sensitivity, specificity of the NMP22 was 91.5% and 68.8% respectively. 31.3% of the cases were false positive and 8.8% of the cases were false negative. Conclusions: NMP22 and Cytokeratin 20 appear to be promising biomarkers that can be used as an alternate or adjunct tool for the diagnosis of patients with bladder cancer and their effective management.
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