Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
Urology. 2010 Jun;75(6):1278-82. doi: 10.1016/j.urology.2009.09.091. Epub 2010 Feb 7.
To evaluate performance and cost-effectiveness of voided cytology in patients with pure asymptomatic microscopic hematuria (AMH). Although voided cytology has been validated for use in patients with a history of urothelial carcinoma (UC), its use in low-risk patients with AMH is controversial.
A total of 200 consecutive low-risk patients (median age, 64 years) with AMH were referred to the urology clinic between 2005 and 2007. All underwent cystoscopy, upper tract imaging, and voided urinary cytology. Results of voided cytology were classified as positive, atypical, or negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and costs were calculated.
None had positive cytology, 23 (11.5%) had atypical cytology, and 177 (88.5%) had negative urinary cytology. Of 200 patients, 8 (4%) were found to have low-grade UC of bladder via cystoscopy; the cytology was negative in 4 patients and atypical in 4. Of 8, 4 were Ta and 4 were pT1 tumors. There was no upper urinary tract or renal malignancy identified. If atypical cytology was considered as positive, the sensitivity, specificity, PPV, and NPV of cytology were 50%, 90%, 17%, and 98%, respectively. If atypical cytology was considered as negative, the sensitivity, specificity, PPV, and NPV of cytology were 0%, 100%, 0%, and 96%, respectively. Cost of performing urinary cytology was estimated at $262.50 per patient.
Although this study supports evaluating patients with AMH because a significant percentage of patients will have UC, voided urine cytology added a significant cost without any diagnostic benefit in the work-up of low-risk patients with AMH.
评估在单纯无症状性镜下血尿（AMH）患者中，尿液脱落细胞学检查的性能和成本效益。尽管尿液脱落细胞学检查已被验证可用于有尿路上皮癌（UC）病史的患者，但在 AMH 低风险患者中的应用仍存在争议。
2005 年至 2007 年间，共有 200 例连续的 AMH 低风险患者（中位年龄 64 岁）被转至泌尿科诊所。所有患者均接受了膀胱镜检查、上尿路影像学检查和尿液脱落细胞学检查。尿液脱落细胞学检查结果分为阳性、非典型或阴性。计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和成本。
无阳性细胞学检查结果，23 例（11.5%）为非典型细胞学检查结果，177 例（88.5%）为阴性尿液细胞学检查结果。200 例患者中，有 8 例（4%）通过膀胱镜检查发现低级别膀胱癌；4 例细胞学检查结果为阴性，4 例为非典型。这 8 例中，有 4 例为 Ta 期肿瘤，4 例为 pT1 期肿瘤。未发现上尿路或肾脏恶性肿瘤。如果将非典型细胞学检查结果视为阳性，那么细胞学检查的敏感性、特异性、PPV 和 NPV 分别为 50%、90%、17%和 98%。如果将非典型细胞学检查结果视为阴性，那么细胞学检查的敏感性、特异性、PPV 和 NPV 分别为 0%、100%、0%和 96%。尿液细胞学检查的费用估计为每位患者 262.50 美元。
尽管本研究支持评估 AMH 患者，因为有相当比例的患者会患有 UC，但在 AMH 低风险患者的检查中，尿液脱落细胞学检查增加了显著的成本，却没有任何诊断益处。
