Sawczuk I S, Bagiella E, Sawczuk A T, Yun E J
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Cancer Detect Prev. 2000;24(4):364-8.
The combination of a noninvasive, quantitative immunoassay, NMP22, with voided urinary cytology prior to cystoscopy was evaluated in patients with urothelial transitional cell carcinoma. Fifty-six patients with a history of transitional cell carcinoma were evaluated. Voided urine was obtained for NMP22 and cytology prior to cystoscopy. One hundred and twenty-three NMP22 assays, 124 cytologies, and 124 cystoscopies were performed. The type of anesthesia used for cystoscopic evaluation was determined by the NMP22 value in 30 patients. Cystoscopy results were considered positive on biopsy-confirmed malignancy. The reference value used for NMP22 was 10.0 U/ml. NMP22, cytology, and the combination of NMP22 and cytology were compared to cystoscopy and to pathologic grading and staging. Thirty-four recurrent transitional cell carcinoma episodes occurred; 22 were low-grade (I-II), and 12 were high-grade (III-IV). Twenty-seven were stage Ta; four were T1; and three were T3b or 4. Within this group, NMP22 detected low- and high-grade tumors equally, as compared to cytology, which was sensitive only to high-grade tumors. Nineteen patients were NMP22-negative and underwent cystoscopy under topical anesthesia; 17 were tumor-free. Eleven patients were NMP22-positive and had anesthesia, and all had visible lesions, which were subjected to biopsy and were resected. Six lesions were tumors, five were inflammatory. Overall sensitivity of combined NMP22 and cytology was 70%; specificity was 72%; positive predictive value was 54%; and negative predictive value was 77%. An accurate assessment of the risk of a bladder cancer can be obtained with NMP22, cytology, and cystoscopy in patients with a history of bladder cancer. NMP22 values can be used to determine the level of anesthesia for cystoscopy in patients with a history of bladder cancer.
在尿路上皮移行细胞癌患者中，对一种非侵入性定量免疫测定法NMP22与膀胱镜检查前的晨尿细胞学检查相结合的方法进行了评估。对56例有移行细胞癌病史的患者进行了评估。在膀胱镜检查前采集晨尿用于NMP22检测和细胞学检查。进行了123次NMP22检测、124次细胞学检查和124次膀胱镜检查。30例患者根据NMP22值确定膀胱镜检查评估所用麻醉类型。膀胱镜检查结果在活检证实为恶性肿瘤时被视为阳性。NMP22的参考值为10.0 U/ml。将NMP22、细胞学检查以及NMP22与细胞学检查的联合结果与膀胱镜检查结果以及病理分级和分期进行比较。发生了34次复发性移行细胞癌事件；22例为低级别（I-II级），12例为高级别（III-IV级）。27例为Ta期；4例为T1期；3例为T3b或T4期。在该组中，与仅对高级别肿瘤敏感的细胞学检查相比，NMP22对低级别和高级别肿瘤的检测能力相同。19例NMP22检测为阴性的患者在局部麻醉下接受了膀胱镜检查；17例未发现肿瘤。11例NMP22检测为阳性的患者接受了麻醉，所有患者均有可见病变，对病变进行了活检并切除。6个病变为肿瘤，5个为炎症。NMP22与细胞学检查联合的总体敏感性为70%；特异性为72%；阳性预测值为54%；阴性预测值为77%。对于有膀胱癌病史的患者，通过NMP22、细胞学检查和膀胱镜检查可以准确评估膀胱癌风险。NMP22值可用于确定有膀胱癌病史患者膀胱镜检查的麻醉水平。
