Talwar Raghav, Sinha Tapan, Karan S C, Doddamani D, Sandhu A, Sethi G S, Srivastava A, Narang V, Agarwal A, Adhlakha N
Department of Urology, Army Hospital (Research and Referral), New Delhi, India.
Urology. 2007 Aug;70(2):267-71. doi: 10.1016/j.urology.2007.03.070.
The sensitivity of voided urinary cytology has been reported as very low. In this study, we investigated the sensitivity and clinical utility of voided urinary cytology in the detection of various grades and stages of transitional cell carcinoma (TCC) of the bladder compared with the urinary nuclear matrix protein-22 (NMP-22) qualitative assay.
From March 2004 to April 2006, all patients with TCC of the bladder receiving follow-up care and those presenting with gross hematuria were enrolled in this prospective study. These patients underwent urinary cytologic examination and NMP-22 qualitative assay. The diagnosis, determined from the cystoscopy findings and biopsy findings of the suspicious lesion, was accepted as the reference standard.
A total of 196 patients were enrolled in this study, of whom 127 patients had previously been diagnosed with bladder TCC and 69 were presenting for investigation of gross hematuria. A total of 52 cases of bladder TCC were diagnosed. The overall sensitivity of voided urine cytology and NMP-22 assay was 21.1% and 67.3%, respectively (P <0.001). The sensitivity of urinary cytology and urinary NMP-22 for well-differentiated tumors was 9.5% and 52.4%, respectively, and was 18.1% and 77.3%, respectively (P <0.001), in moderately differentiated tumors. The overall specificity of urinary cytology for TCC of the bladder was 98.6% and was greater than the specificity of NMP-22 (80.5%).
The results of our study suggest that urinary cytology has a very low sensitivity and can be omitted in favor of NMP-22 in the follow-up of low-grade superficial bladder TCC.
据报道，排尿尿细胞学检查的敏感性很低。在本研究中，我们将排尿尿细胞学检查与尿核基质蛋白-22（NMP-22）定性检测相比较，研究其在检测膀胱移行细胞癌（TCC）不同分级和分期中的敏感性及临床应用价值。
2004年3月至2006年4月，所有接受随访的膀胱TCC患者以及出现肉眼血尿的患者均纳入本前瞻性研究。这些患者接受了尿细胞学检查和NMP-22定性检测。根据膀胱镜检查结果和可疑病变的活检结果确定的诊断被视为参考标准。
本研究共纳入196例患者，其中127例患者先前已被诊断为膀胱TCC，69例因肉眼血尿前来检查。共诊断出52例膀胱TCC。排尿尿细胞学检查和NMP-22检测的总体敏感性分别为21.1%和67.3%（P<0.001）。尿细胞学检查和尿NMP-22对高分化肿瘤的敏感性分别为9.5%和52.4%，对中分化肿瘤的敏感性分别为18.1%和77.3%（P<0.001）。膀胱TCC尿细胞学检查的总体特异性为98.6%，高于NMP-22的特异性（80.5%）。
我们的研究结果表明尿细胞学检查敏感性很低，在低级别浅表性膀胱TCC的随访中，可不用尿细胞学检查，而采用NMP-22检测。
