Planz B, Synek C, Robben J, Böcking A, Marberger M
Department of Urology, University of Vienna, Vienna, Austria.
Urology. 2000 Nov 1;56(5):782-6. doi: 10.1016/s0090-4295(00)00765-2.
To assess the potential of DNA image cytometry in screening for bladder cancer, compare it with conventional urinary cytology, and evaluate its possible use in routine urinary evaluation. Urinary cytology is still the most common method for detection of bladder cancer in routine clinical use. The considerable shortcomings of urinary cytology include its low sensitivity in low-grade carcinomas and its poor reproducibility.
Spontaneously voided urine specimens from 40 patients with grade 1 (n = 27), grade 2 (n = 10), and grade 3 (n = 3) histologically proven transitional cell carcinoma and 40 patients with symptomatic urologic disease of the bladder were analyzed by cytology and DNA image cytometry. The DNA content was determined by use of the CM-1 Cytometer according to the guidelines in the ESACP Consensus Report on Standardization of DNA Image Cytometry.
Urinary cytology yielded an overall sensitivity of 47.5%. Conventional analysis of DNA histograms measuring the presence of DNA stemline aneuploidy (1.8c > stemline ploidy [STP] > 2.2c) revealed a sensitivity of 62.5%; applying the stemline interpretation according to Böcking et al. increased the overall sensitivity to 75%. The specificity of both methods was 100%. DNA image cytometry demonstrated a high sensitivity in grade 1 tumors (70.4%) compared with cytology (26%).
In light of its highly improved sensitivity compared with urinary cytology, DNA image cytometry should be used to evaluate suspect urothelial cells in urinary cytology specimens. Since the method provides more objective and reproducible results with a specificity comparable to that of cytology, we encourage its primary application in the screening for bladder cancer, provided these results can be confirmed in a multicenter evaluation study.
评估DNA图像细胞术在膀胱癌筛查中的潜力，将其与传统尿液细胞学检查进行比较，并评估其在常规尿液评估中的可能用途。尿液细胞学检查仍是常规临床中检测膀胱癌最常用的方法。尿液细胞学检查存在相当多的缺点，包括对低级别癌的敏感性低以及重复性差。
对40例经组织学证实为1级（n = 27）、2级（n = 10）和3级（n = 3）移行细胞癌的患者以及40例有膀胱症状性泌尿系统疾病的患者的自然排尿尿液标本进行细胞学检查和DNA图像细胞术分析。根据ESACP关于DNA图像细胞术标准化的共识报告中的指南，使用CM-1细胞仪测定DNA含量。
尿液细胞学检查的总体敏感性为47.5%。对测量DNA主干线非整倍体存在情况（1.8c > 主干线倍体[STP] > 2.2c）的DNA直方图进行常规分析，敏感性为62.5%；按照Böcking等人的主干线解释方法，总体敏感性提高到75%。两种方法的特异性均为100%。与细胞学检查（26%）相比，DNA图像细胞术在1级肿瘤中的敏感性较高（70.4%）。
鉴于与尿液细胞学检查相比其敏感性有了显著提高，DNA图像细胞术应用于评估尿液细胞学标本中可疑的尿路上皮细胞。由于该方法能提供更客观、可重复的结果，且特异性与细胞学检查相当，我们鼓励在膀胱癌筛查中首先应用该方法，前提是这些结果能在多中心评估研究中得到证实。
