Chen G L, El-Gabry E A, Bagley D H
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Urol. 2000 Dec;164(6):1901-4. doi: 10.1016/s0022-5347(05)66913-3.
A select group of patients with upper tract transitional cell carcinoma are treated with ureteroscopic resection. We determine the validity and accuracy of urinalysis, bladder cytology, upper tract biopsy/cytology and retrograde pyelography for the detection of recurrent upper tract transitional cell carcinoma compared to endoscopic findings.
Patients with ureteroscopically treated upper tract transitional cell carcinoma were followed with surveillance every 3 to 6 months. Surveillance included urinalysis with dipstick and microscopic examination, bladder cytology, retrograde pyelography read by a urologist and radiologist, and ureteropyeloscopy with cytology and biopsy of suspicious areas. Not all results were available for all surveillance procedures. Measures of sensitivity and specificity for the aforementioned surveillance procedures were determined relative to endoscopic findings that were defined as the standard. Confidence intervals were also estimated. Initially, a generalized estimation equation approach was used to take into account the clustering of repeated testing within patients. The accuracy of each procedure was also calculated.
There were 23 patients with previously resected low grade upper tract transitional cell carcinoma who underwent a total of 88 surveillances in 30 months. A total of 56 of 88 (64%) recurrences were detected ureteroscopically, including 11 (12%) associated bladder recurrences. In patients who did not have bladder recurrences urinalysis had a sensitivity of 37.5% but specificity was 85%, while bladder cytology had a sensitivity of 50% and specificity was 100%, and retrograde pyelography read in the endoscopy room revealed a sensitivity of 71.7% and specificity of 84.7%. Ureteroscopic biopsy/cytology had a sensitivity and specificity of 93.4% and 65.2%, respectively.
Our findings indicate that compared to ureteroscopy, urinalysis, bladder cytology, retrograde pyelography and ureteroscopic cytology/biopsy are less valid and accurate in detecting upper tract transitional cell carcinoma recurrences. Based on our data we recommend ureteroscopic evaluation as an essential procedure for the surveillance of patients treated endoscopically for upper tract transitional cell carcinoma.
一组特定的上尿路移行细胞癌患者接受输尿管镜切除术治疗。我们将尿液分析、膀胱细胞学检查、上尿路活检/细胞学检查和逆行肾盂造影与内镜检查结果相比较，以确定其在检测复发性上尿路移行细胞癌方面的有效性和准确性。
对接受输尿管镜治疗的上尿路移行细胞癌患者每3至6个月进行一次随访监测。监测包括用试纸条进行尿液分析及显微镜检查、膀胱细胞学检查、由泌尿科医生和放射科医生解读的逆行肾盂造影，以及对可疑区域进行输尿管肾盂镜检查并做细胞学检查和活检。并非所有监测程序的结果都可获取。相对于被定义为标准的内镜检查结果，确定上述监测程序的敏感性和特异性指标。还估计了置信区间。最初，采用广义估计方程方法来考虑患者体内重复检测的聚类情况。还计算了每个程序的准确性。
23例曾接受低级别上尿路移行细胞癌切除术的患者在30个月内共接受了88次监测。88次监测中共有56例（64%）复发通过输尿管镜检查发现，其中包括11例（12%）合并膀胱复发。在无膀胱复发的患者中，尿液分析的敏感性为37.5%，但特异性为85%；膀胱细胞学检查的敏感性为50%，特异性为100%；在内镜检查室解读的逆行肾盂造影显示敏感性为71.7%，特异性为84.7%。输尿管镜活检/细胞学检查的敏感性和特异性分别为93.4%和65.2%。
我们的研究结果表明，与输尿管镜检查相比，尿液分析、膀胱细胞学检查、逆行肾盂造影以及输尿管镜细胞学检查/活检在检测上尿路移行细胞癌复发方面的有效性和准确性较低。基于我们的数据，我们建议输尿管镜评估作为接受内镜治疗的上尿路移行细胞癌患者监测的必要程序。
