Boman Hans, Hedelin Hans, Jacobsson Stefan, Holmäng Sten
Department of Surgery, Alingsås Lasarett, Kärnsjukhuset, Skövde, Sweden.
J Urol. 2002 Nov;168(5):1955-9. doi: 10.1016/S0022-5347(05)64271-1.
We recorded initial symptoms and evaluated the frequency and intensity of hematuria in patients with newly diagnosed bladder cancer. We also evaluated and compared the sensitivity of bladder wash cytology, NMP22 (Matritech, Newton, Massachusetts), BTA Stat (Bion Diagnostic Sciences, Redmond, Washington) and UBC antigen (IDL Biotech, Sollentona, Sweden) with hematuria dipsticks and flow cytometry for determining the size of erythrocytes in urine.
Urine samples were collected from 92 patients with newly diagnosed bladder cancer, 64 with idiopathic microhematuria and 42 with nephritis. Urine was analyzed for NMP22, BTA Stat, UBC and erythrocytes size using flow cytometry. Bladder wash cytology was done at cystoscopy. Urine was analyzed for microhematuria with hematuria dipsticks at home for 7 consecutive days immediately before the operation and in the hospital on the day of surgery.
Sensitivity was 75% for NMP22, 78% for BTA Stat, 64% for UBC and 61% for flow cytometry at 73% specificity. Cytology had 42% sensitivity at 97% specificity. Tumor size, grade and stage had a statistically significant influence on NMP22, BTA Stat, UBC and cytology. Of the patients 75% had microhematuria on the day of the operation and 75% had hematuria at least 1 of 7 days when tested at home the last week before transurethral bladder resection. The 70% of all patients with macroscopic hematuria as the initial symptom did not seem to differ from those without the condition in tumor size, grade, stage or tumor marker levels.
Flow cytometry was not well enough able to distinguish patients with bladder cancer from controls. The sensitivity of all tested markers, including hematuria dipsticks, was high for large and high grade, high stage tumors. Further studies are needed to evaluate whether a marker could be used to determine priority among patients referred due to microhematuria.
我们记录了新诊断膀胱癌患者的初始症状，并评估了血尿的频率和强度。我们还评估并比较了膀胱冲洗细胞学检查、NMP22（马特里泰克公司，马萨诸塞州牛顿市）、BTA Stat（生物诊断科学公司，华盛顿州雷德蒙德市）和UBC抗原（IDL生物技术公司，瑞典索伦托纳市）与血尿试纸条及流式细胞术检测尿中红细胞大小的敏感性。
收集了92例新诊断膀胱癌患者、64例特发性微血尿患者和42例肾炎患者的尿液样本。使用流式细胞术分析尿液中的NMP22、BTA Stat、UBC和红细胞大小。膀胱冲洗细胞学检查在膀胱镜检查时进行。在手术前连续7天在家中以及手术当天在医院使用血尿试纸条分析尿液中的微血尿情况。
在特异性为73%时，NMP22的敏感性为75%，BTA Stat为78%，UBC为64%，流式细胞术为61%。细胞学检查在特异性为97%时敏感性为42%。肿瘤大小、分级和分期对NMP22、BTA Stat、UBC和细胞学检查有统计学显著影响。75%的患者在手术当天有微血尿，75%的患者在经尿道膀胱切除术前最后一周在家中检测时，7天中至少有1天有血尿。以肉眼血尿为初始症状的所有患者中，70%在肿瘤大小、分级、分期或肿瘤标志物水平方面似乎与无此症状的患者无差异。
流式细胞术不足以很好地区分膀胱癌患者与对照组。包括血尿试纸条在内的所有检测标志物对大的、高级别、高分期肿瘤的敏感性较高。需要进一步研究以评估是否可以使用一种标志物来确定因微血尿转诊患者的优先级。
