{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:47:16Z","timestamp":1792158436799,"version":"4.4.0"},"reference-count":29,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-1514_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Bladder cancer (BC) has a high recurrence rate, requiring invasive procedures such as cystoscopy and histopathological examination. Existing non-invasive methods, including urine cytology, fluorescence\n                      <jats:italic>in situ<\/jats:italic>\n                      hybridization (FISH), and tumor markers like nuclear matrix protein 22 (NMP22), have limited sensitivity and specificity. This study assessed the potential of low-cost, non-invasive urine sediment data for BC detection using a machine learning\u00a0model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1514_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Urine sediment data from 1,341 patients (577 with BC and 764 with benign conditions) were obtained using a\u00a0fully automated urinary particle analyzer (UF-5000). One preoperative sample per patient was included. A soft-voting ensemble model combining random forest and logistic regression was developed. Class imbalance was addressed using the Synthetic Minority Oversampling Technique, and feature selection was guided by the variance inflation factor. Model performance was evaluated using the area under the\u00a0receiver operating characteristic curve (AUC), balanced accuracy, sensitivity, and specificity, with 95\u202f% confidence intervals estimated via bootstrapping. Model stability was evaluated using fivefold cross-validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1514_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ensemble model achieved an AUC of 0.89, with a sensitivity of 0.80 and specificity of 0.88. Balanced accuracy was 0.84, and cross-validation demonstrated stable performance (accuracy 0.80). Feature importance analysis identified atypical cells and red blood cells as the most influential predictors, particularly of non-muscle-invasive\u00a0BC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-1514_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This urine sediment\u2013based, non-invasive approach shows promise for the early detection and monitoring of BC. Its integration into routine clinical workflows may enhance screening efficiency without additional\u00a0costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-1514","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:56:02Z","timestamp":1792155362000},"source":"Crossref","is-referenced-by-count":0,"title":["Enhanced detection of bladder cancer using machine learning analysis of routine urinary sediment data"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9904-3451","authenticated-orcid":false,"given":"Rikiya","family":"Okuyama","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory , NTT Medical Center Tokyo , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology , NTT Medical Center Tokyo , Tokyo , Japan"},{"name":"Department of Molecular Pathology , Tokyo Medical University , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Urology , NTT Medical Center Tokyo , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuaki","family":"Muroya","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory , NTT Medical Center Tokyo , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teppei","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology , NTT Medical Center Tokyo , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"2026101612555898515_j_cclm-2026-1514_ref_001","doi-asserted-by":"crossref","unstructured":"Burger, M, Catto, JWF, Dalbagni, G, Grossman, HB, Herr, H, Karakiewicz, P, et al.. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013;63:234\u201341. https:\/\/doi.org\/10.1016\/j.eururo.2012.07.033.","DOI":"10.1016\/j.eururo.2012.07.033"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_002","unstructured":"Ministry of Health, Labour and Welfare Japan. Overview of the 2023 vital statistics (final figures) [Internet]. https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/jinkou\/kakutei23\/index.html [Accessed 6 Jul 2025]."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_003","doi-asserted-by":"crossref","unstructured":"Yafi, FA, Brimo, F, Auger, M, Aprikian, A, Tanguay, S, Kassouf, W. Is the performance of urinary cytology as high as reported historically? A\u00a0contemporary analysis in the detection and surveillance of bladder cancer. Urol Oncol 2014;32:e1\u20136. https:\/\/doi.org\/10.1016\/j.urolonc.2012.09.011.","DOI":"10.1016\/j.urolonc.2012.09.011"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_004","doi-asserted-by":"crossref","unstructured":"Li, HX, Wang, MR, Zhao, H, Cao, J, Li, CL, Pan, QJ. Comparison of fluorescence in\u00a0situ hybridization, NMP22 bladderchek, and urinary liquid-based cytology in the detection of bladder urothelial carcinoma. Diagn Cytopathol 2013;41:852\u20137. https:\/\/doi.org\/10.1002\/dc.22969.","DOI":"10.1002\/dc.22969"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_005","doi-asserted-by":"crossref","unstructured":"Becker, GJ, Garigali, G, Fogazzi, GB. Advances in urine microscopy. Am J\u00a0Kidney Dis 2016;67:954\u201364. https:\/\/doi.org\/10.1053\/j.ajkd.2015.11.011.","DOI":"10.1053\/j.ajkd.2015.11.011"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_006","doi-asserted-by":"crossref","unstructured":"Kucukgergin, C, Ademoglu, E, Omer, B, Genc, S. Performance of automated urine analyzers using flow cytometric and digital image-based technology in routine urinalysis. Scand J Clin Lab Invest 2019;79:468\u201374. https:\/\/doi.org\/10.1080\/00365513.2019.1658894.","DOI":"10.1080\/00365513.2019.1658894"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_007","unstructured":"Sysmex Corporation. UF-5000: fully automated urine particle analyzer [Internet]. https:\/\/www.sysmex.com\/en-us\/lab-solutions\/urinalysis\/un-series\/uf-5000 [Accessed 6 Jul 2025]."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_008","doi-asserted-by":"crossref","unstructured":"Ren, C, Wang, X, Yang, C, Li, S, Liu, S, Cao, H. Investigation of Atyp. C using UF-5000 flow cytometer in patients with a suspected diagnosis of urothelial carcinoma: a single-center study. Diagn Pathol 2020;15:77. https:\/\/doi.org\/10.1186\/s13000-020-00993-1.","DOI":"10.1186\/s13000-020-00993-1"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_009","doi-asserted-by":"crossref","unstructured":"Shukuya, K, Morita, Y, Hisasue, T, Ono, Y, Tomiyasu, S, Kurano, M, et al.. Comparison of the clinical performance of the Atyp. C parameter of the UF-5000 fully automated urine particle analyzer with that of microscopic urine sediment analysis. Pract Lab Med 2023;36:e00328. https:\/\/doi.org\/10.1016\/j.plabm.2023.e00328.","DOI":"10.1016\/j.plabm.2023.e00328"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_010","unstructured":"Sakai, R, Ishikawa, M, Matsumoto, S, Shimada, H, Ogawa, M. Comparison of Atyp. C value in the fully automatic urinary particle analyzer UF-5000 with results of urine cytology and urine sediment examination. Jpn J\u00a0Med Technol 2023;72:210\u20135."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_011","unstructured":"Chen, Y, Zhang, Z, Lin, Z, Wu, Y, Zhao, Y, Wang, G, et al.. Sysmex UF-5000 automatic urine sediment analyzer can improve the accuracy of epithelial cell detection. Ann Clin Lab Sci 2021;51:562\u20139."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_012","unstructured":"Pedregosa, F, Varoquaux, G, Gramfort, A, Michel, V, Thirion, B, Grisel, O, et al.. Scikit-learn: machine learning in python. J\u00a0Mach Learn Res 2011;12:2825\u201330."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_013","doi-asserted-by":"crossref","unstructured":"Seabold, S, Perktold, J. Statsmodels: econometric and statistical modeling with Python. In: Proceedings of the 9th Python in Science Conference (SciPy 2010). Python for Scientific Computing, Austin, TX; 2010.","DOI":"10.25080\/Majora-92bf1922-011"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_014","doi-asserted-by":"crossref","unstructured":"Chawla, NV, Bowyer, KW, Hall, LO, Kegelmeyer, WP. SMOTE: synthetic minority over-sampling technique. J\u00a0Artif Intell Res 2002;16:321\u201357. https:\/\/doi.org\/10.1613\/jair.953.","DOI":"10.1613\/jair.953"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_015","doi-asserted-by":"crossref","unstructured":"Platt, J. Probabilistic outputs for support vector machines and comparisons to regularized likelihood methods. Adv Large Margin Classif 1999;10:61\u201374.","DOI":"10.7551\/mitpress\/1113.003.0008"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_016","unstructured":"Kohavi, R. A study of cross-validation and bootstrap for accuracy estimation and model selection. In: Proceedings of the 14th International Joint Conference on Artificial Intelligence (IJCAI 1995). Montreal, Canada: Morgan Kaufmann Publishers; 1995."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_017","doi-asserted-by":"crossref","unstructured":"Hunter, JD. Matplotlib: a 2D graphics environment. Comput Sci Eng 2007;9:90\u20135. https:\/\/doi.org\/10.1109\/mcse.2007.55.","DOI":"10.1109\/MCSE.2007.55"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_018","doi-asserted-by":"crossref","unstructured":"Luo, Y, She, DL, Xiong, H, Yang, L, Fu, SJ. Diagnostic value of liquid-based cytology in urothelial carcinoma diagnosis: a systematic review and meta-analysis. PLoS One 2015;10:e0134940. https:\/\/doi.org\/10.1371\/journal.pone.0134940.","DOI":"10.1371\/journal.pone.0134940"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_019","doi-asserted-by":"crossref","unstructured":"Ecke, TH, Meisl, CJ, Schlomm, T, Rabien, A, Labont\u00e9, F, Rong, D, et al.. BTA stat\u00ae, NMP22\u00ae BladderChek\u00ae, UBC\u00ae Rapid test, and CancerCheck\u00ae UBC\u00ae rapid VISUAL as urinary marker for bladder cancer: final results of a German multicenter study. Urol Oncol 2023;41:484.e17\u201326. https:\/\/doi.org\/10.1016\/j.urolonc.2023.06.013.","DOI":"10.1016\/j.urolonc.2023.06.013"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_020","doi-asserted-by":"crossref","unstructured":"Pichler, R, Tulchiner, G, Fritz, J, Schaefer, G, Horninger, W, Heidegger, I. Urinary UBC Rapid and NMP22 test for bladder cancer surveillance in comparison to urinary cytology: results from a prospective single-center study. Int J Med Sci 2017;14:811\u20139. https:\/\/doi.org\/10.7150\/ijms.19929.","DOI":"10.7150\/ijms.19929"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_021","doi-asserted-by":"crossref","unstructured":"Bhat, A, Ritch, CR. Urinary biomarkers in bladder cancer: where do we stand? Curr Opin Urol 2019;29:203\u20139. https:\/\/doi.org\/10.1097\/mou.0000000000000605.","DOI":"10.1097\/MOU.0000000000000605"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_022","doi-asserted-by":"crossref","unstructured":"Zhou, L, Yang, K, Li, X, Ding, Y, Mu, D, Li, H, et al.. Application of fluorescence in\u00a0situ hybridization in the detection of bladder transitional-cell carcinoma: a multi-center clinical study based on Chinese population. Asian J Urol 2019;6:114\u201321. https:\/\/doi.org\/10.1016\/j.ajur.2018.06.001.","DOI":"10.1016\/j.ajur.2018.06.001"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_023","doi-asserted-by":"crossref","unstructured":"Grocela, JA, McDougal, WS. Utility of nuclear matrix protein (NMP22) in the detection of recurrent bladder cancer. Urol Clin North Am 2000;27:47\u201351. https:\/\/doi.org\/10.1016\/s0094-0143(05)70233-0.","DOI":"10.1016\/S0094-0143(05)70233-0"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_024","doi-asserted-by":"crossref","unstructured":"Arora, VK, Sarungbam, J, Bhatia, A, Singh, N, Agrawal, V, Aggarwal, S. Usefulness of NMP22 as an adjunct to a typical urine cytology and low-grade urothelial carcinoma. Diagn Cytopathol 2010;38:788\u201390. https:\/\/doi.org\/10.1002\/dc.21286.","DOI":"10.1002\/dc.21286"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_025","doi-asserted-by":"crossref","unstructured":"Ren, C, Qian, W. A model based on automated urinalysis parameters for urothelial carcinoma risk stratification in suspected patients. Clin Lab 2024;70:1886. https:\/\/doi.org\/10.7754\/clin.lab.2024.240330.","DOI":"10.7754\/Clin.Lab.2024.240330"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_026","doi-asserted-by":"crossref","unstructured":"Morita, Y, Yokoyama, R, Tanaka, M, Nakatsuka, N, Hisasue, T, Ono, Y, et al.. Evaluation of the fully automated urine particle analyzer UF-1500. J\u00a0Clin Lab Anal 2023;37:e24993. https:\/\/doi.org\/10.1002\/jcla.24993.","DOI":"10.1002\/jcla.24993"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_027","doi-asserted-by":"crossref","unstructured":"Previtali, G, Ravasio, R, Seghezzi, M, Buoro, S, Alessio, MG. Performance evaluation of the new fully automated urine particle analyser UF-5000 compared to the reference method of the Fuchs-Rosenthal chamber. Clin Chim Acta 2017;472:123\u201330. https:\/\/doi.org\/10.1016\/j.cca.2017.07.028.","DOI":"10.1016\/j.cca.2017.07.028"},{"key":"2026101612555898515_j_cclm-2026-1514_ref_028","unstructured":"Kovacs, EMR, Senden, JMG, Brouns, F. Urine color, osmolality and specific electrical conductance are not accurate measures of hydration status during postexercise rehydration. J\u00a0Sports Med Phys Fitness 1999;39:47\u201353."},{"key":"2026101612555898515_j_cclm-2026-1514_ref_029","doi-asserted-by":"crossref","unstructured":"Travers, S, Prot-Bertoye, C, Daudon, M, Courbebaisse, M, Baron, S. How to monitor hydration status and urine dilution in patients with nephrolithiasis. Nutrients 2023;15:1642. https:\/\/doi.org\/10.3390\/nu15071642.","DOI":"10.3390\/nu15071642"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-1514\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-1514\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:56:06Z","timestamp":1792155366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-1514\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":29,"alternative-id":["10.1515\/cclm-2026-1514"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2026-1514","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"value":"1434-6621","type":"print"},{"value":"1437-4331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]}}}