Casella R, Huber P, Blöchlinger A, Stoffel F, Dalquen P, Gasser T C, Lehmann K
Urologic Clinic, Department of Central Laboratories, University Hospital Basel, Switzerland.
J Urol. 2000 Dec;164(6):1926-8.
We prospectively evaluated the value of nuclear matrix protein 22 (NMP22dagger) and cytology in the diagnosis of bladder cancer.
We analyzed NMP22 in voided urine from 235 patients before cystoscopy. Of the patients 130 had transitional cell carcinoma of the bladder and subsequently underwent surgery. In a subset of 200 patients bladder washout samples for cytology were collected during cystoscopy. The cutoff for NMP22 was 10.0 units per ml. For cytology only high grade atypia was considered positive.
Histology showed 77 superficial (pTa, pTis) and 53 invasive (pT1 or greater) tumors. Sensitivity of NMP22 was 51% and specificity was 83%. NMP22 sensitivity was 36% for superficial tumors and 73% for invasive transitional cell carcinoma. Overall sensitivity of cytology was 52% and specificity was 89%. Cytology sensitivity was 38% for superficial tumors and 83% for invasive transitional cell carcinoma. NMP22 sensitivity for grades 1, 2 and 3 tumors was 30%, 56% and 68%, respectively. Cytology sensitivity for grades 1, 2 and 3 tumors was 30%, 50% and 91%, respectively. Combined NMP22 and cytology had a sensitivity of 70%.
NMP22 has sensitivity and specificity similar to those of cytology from bladder washout samples. Particularly in low stage and low grade tumors both tests show the same disappointing sensitivity. Because of a false-negative rate of 49%, NMP22 cannot replace cystoscopy in clinical practice, as the danger of missing NMP22 negative tumors is too high to rely on its results in an individual patient.
我们前瞻性地评估了核基质蛋白22（NMP22†）及细胞学检查在膀胱癌诊断中的价值。
我们对235例患者膀胱镜检查前的晨尿中的NMP22进行了分析。其中130例患者患有膀胱移行细胞癌，随后接受了手术。在200例患者的一个亚组中，膀胱镜检查期间收集了用于细胞学检查的膀胱冲洗样本。NMP22的临界值为每毫升10.0单位。对于细胞学检查，仅高级别异型性被视为阳性。
组织学检查显示77例表浅（pTa、pTis）肿瘤和53例浸润性（pT1或更高分期）肿瘤。NMP22的敏感性为51%，特异性为83%。表浅肿瘤中NMP22的敏感性为36%，浸润性移行细胞癌中为73%。细胞学检查的总体敏感性为52%，特异性为89%。表浅肿瘤中细胞学检查的敏感性为38%，浸润性移行细胞癌中为83%。1级、2级和3级肿瘤中NMP22的敏感性分别为30%、56%和68%。1级、2级和3级肿瘤中细胞学检查的敏感性分别为30%、50%和91%。联合NMP22和细胞学检查的敏感性为70%。
NMP22的敏感性和特异性与膀胱冲洗样本的细胞学检查相似。特别是在低分期和低级别肿瘤中，两种检查的敏感性都令人失望。由于假阴性率为49%，NMP22在临床实践中不能替代膀胱镜检查，因为漏诊NMP22阴性肿瘤的风险过高，无法仅依靠其结果来评估个体患者。
