Li Min, Li Hong-xia, Guo Hui-qin, Zhao Huan, Zhao Lin-lin, Ma Jian-hui, Li Chang-ling, Cao Jian, Pan Qin-jing
Department of Pathology, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Zhong Liu Za Zhi. 2012 Sep;34(9):669-73. doi: 10.3760/cma.j.issn.0253-3766.2012.09.006.
To investigate the value of cytokeratin 20 (CK20) immunocytochemical (ICC) detection in the urine liquid-based cytological specimens in diagnosis of urothelial carcinoma (UC).
The study consisted of prospective and retrospective groups. In the prospective group, voided urine samples were collected from patients with a variety of urological conditions and healthy individuals. Urine cytological diagnosis and CK20 ICC were performed on the collected specimens. In the retrospective group, archived urine slides with cytological diagnoses of atypical urothelial cells (AUC), suspicious carcinoma (SuCA) and carcinoma (CA) were selected. Then they were re-stained immunocytochemically with monoclonal antibody against CK20 after decolorization. Histological diagnosis and clinical follow-up result were used as the gold standard for analysis.
There were 136 cases in the prospective group, including 89 cases of UC, 19 cases of other urogenital malignancies, 12 cases of benign lesions and 16 cases of normal control. The sensitivity of CK20 ICC in detection of UC was 75.3%, significantly higher than that of LBC (48.3%, P < 0.001). The positive rate of CK20 was 64.7% (22/34) in G1 UC, 73.3% (22/30) in G2 UC, and 91.3% (21/23) in G3 UC (P < 0.001). The specificity of CK20 ICC was 91.5%, the same as that of LBC. There were 163 cases in retrospective group, including 119 cases of UC, 17 cases of other urogenital malignancies and 27 cases of benign lesions. The cytological diagnoses of them were 68 cases of CA, 47 cases of SuCA and 48 cases of AUC. The positive rates of CK20 ICC in UC and non-UC (other urogenital malignancies and benign lesions) cases were 90.8% and 15.9%, respectively, with a statistically very significant difference (P < 0.001). The LBC of all the 119 cases of UC included 62 (52.1%) cases of CA, 35 (29.4%) cases of SuCA and 22 (18.5%) cases of AUC. The positive rates of CK20 in the LBC-diagnosed CA, SuCA and AUC were 96.8%, 97.1% and 63.6%, respectively. The LBC of all the 44 non-UC cases included 6 (13.6%) cases of CA, 12 (27.3%) cases of SuCA and 26 (59.1%) cases of AUC, and the positive rates of CK20 in the LBC-diagnosed CA, SuCA and AUC were 33.3%, 33.3% and 3.8%, respectively. The differences of UC and non-UC cases between the corresponding categories of LBC were significant (P < 0.0001, respectively).
CK20 immunocytochemistry as an auxiliary method to urine liquid-based cytology can increase the sensitivity in detection of urothelial carcinomas.
探讨细胞角蛋白20（CK20）免疫细胞化学（ICC）检测在尿液液基细胞学标本中诊断尿路上皮癌（UC）的价值。
本研究分为前瞻性和回顾性两组。前瞻性组中，收集了患有各种泌尿系统疾病的患者及健康个体的晨尿样本。对采集的标本进行尿液细胞学诊断和CK20 ICC检测。回顾性组中，选取存档的尿液涂片，其细胞学诊断为非典型尿路上皮细胞（AUC）、可疑癌（SuCA）和癌（CA）。脱色后用抗CK20单克隆抗体进行免疫细胞化学重新染色。组织学诊断和临床随访结果用作分析的金标准。
前瞻性组共136例，其中UC 89例，其他泌尿生殖系统恶性肿瘤19例，良性病变12例，正常对照16例。CK20 ICC检测UC的敏感性为75.3%，显著高于液基薄层细胞学（LBC）（48.3%，P<0.001）。CK20在G1期UC中的阳性率为64.7%（22/34），G2期UC中为73.3%（22/30），G3期UC中为91.3%（21/23）（P<0.001）。CK20 ICC的特异性为91.5%，与LBC相同。回顾性组共163例，其中UC 119例，其他泌尿生殖系统恶性肿瘤17例，良性病变27例。其细胞学诊断为CA 68例，SuCA 47例，AUC 48例。CK20 ICC在UC和非UC（其他泌尿生殖系统恶性肿瘤和良性病变）病例中的阳性率分别为90.8%和15.9%，差异具有统计学意义（P<0.001）。119例UC的LBC结果包括CA 62例（5
