Sokol Eric R, Patel Sutchin R, Clemons Jeffrey L, Sung Vivian W, Rardin Charles R, Myers Deborah L
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Women and Infants Hospital, Brown Medical School, Providence, RI, USA.
Am J Obstet Gynecol. 2005 May;192(5):1554-9. doi: 10.1016/j.ajog.2004.10.627.
The purpose of this study was to assess the clinical usefulness of urinary cytology testing for the evaluation of urothelial cancer in women with irritative voiding symptoms who were examined at a urogynecology service.
Urinary cytology studies results that were obtained from January 1, 2000, to December 31, 2002, were cross-matched with the Rhode Island Department of Health Cancer Registry to identify those women who were diagnosed with urinary tract malignancies. The prevalence of urothelial cancer was determined, and the sensitivity, specificity, and positive and negative predictive values of urinary cytologic testing were calculated for 2 common classification strategies: (1) consideration of atypical cytologic test results to be normal and (2) consideration of atypical cytologic test results to be abnormal.
Among 1516 cross-matched cytologic test results from 1324 patients, 5 urothelial cancers were identified. Two of the 5 malignancies were associated with positive cytology results. The prevalence of urothelial cancer was 0.38% (95% CI, 0.1%, 0.9%). When atypical cytology studies were classified as normal, the sensitivity of urinary cytology was 40% (95% CI, 7.2%, 83.0%); the specificity was 99.9% (95% CI, 99.5%, 100%); the positive predictive value was 66.7% (95% CI, 12.5%, 98.2%), and negative predictive value was 99.8% (95% CI, 99.2%, 100%). In contrast, when atypical cytology results were classified as abnormal, the sensitivity and negative predictive value remained the same, but the specificity declined to 93.6% (95% CI, 92.1%, 94.8%), and the positive predictive value decreased to 2.3% (95% CI, 0.4%, 8.8%).
The low prevalence of urothelial cancers and low sensitivity of urinary cytology studies severely limit the usefulness of this test in the evaluation of women with irritative voiding symptoms.
本研究旨在评估尿细胞学检查在评估因膀胱刺激症状而在泌尿妇科接受检查的女性尿路上皮癌方面的临床实用性。
将2000年1月1日至2002年12月31日期间获得的尿细胞学研究结果与罗德岛州卫生部癌症登记处进行交叉匹配，以确定那些被诊断患有尿路恶性肿瘤的女性。确定尿路上皮癌的患病率，并针对两种常见的分类策略计算尿细胞学检查的敏感性、特异性以及阳性和阴性预测值：（1）将非典型细胞学检查结果视为正常；（2）将非典型细胞学检查结果视为异常。
在来自1324名患者的1516份交叉匹配的细胞学检查结果中，发现了5例尿路上皮癌。5例恶性肿瘤中有2例与细胞学阳性结果相关。尿路上皮癌的患病率为0.38%（95%CI，0.1%，0.9%）。当非典型细胞学检查结果被分类为正常时，尿细胞学检查的敏感性为40%（95%CI，7.2%，83.0%）；特异性为99.9%（95%CI，99.5%，100%）；阳性预测值为66.7%（95%CI，12.5%，98.2%），阴性预测值为99.8%（95%CI，99.2%，100%）。相比之下，当非典型细胞学结果被分类为异常时，敏感性和阴性预测值保持不变，但特异性降至93.6%（95%CI，92.1%，94.8%），阳性预测值降至2.3%（95%CI，0.4%，8.8%）。
尿路上皮癌的低患病率和尿细胞学研究的低敏感性严重限制了该检查在评估有膀胱刺激症状女性中的实用性。
