Kim Hyun-Jung, Yoo Ji-Hyeong
Address: Department of Pathology, Inje University, Sanggye Paik Hospital, Seoul, Korea.
Department of Urology, Inje University, Sanggye Paik Hospital, Seoul, Korea.
Cytojournal. 2017 Nov 24;14:27. doi: 10.4103/cytojournal.cytojournal_23_17. eCollection 2017.
Dual immunocytochemistry (DIC) with cytokeratin (CK) 20 and p53 in liquid-based cytology is a tool for improving the accuracy of urine cytology (UC). This study was conducted to compare the diagnostic accuracy of UC alone with that of UC combined with CK20/p53 DIC.
We retrieved urine samples collected between January 2015 and March 2016 stored in PreservCyt®solution that were from cases categorized as malignant, highly suspicious, suspicious, and atypical and that were matched with a subsequent biopsy. We re-prepared 63 samples of 28 patients for DIC and blindly evaluated 63 pairs of original Papanicolaou smears and DIC.
Of the 63 samples, 11 could not be analyzed because of the low number of atypical urothelial cells, and the results of the remaining 52 samples were as follows: 34 positive and 18 negative. The positive predictive value of DIC was 100%, and the negative predictive value was 78%. Fifteen DIC-positive cases, histologically proven as malignant were originally diagnosed as highly suspicious (4), suspicious (8), and atypical (3), which were strongly suggestive of "urothelial carcinoma". Four negative cases, histologically confirmed as non-neoplastic cases, were filtered from false positivity.
Despite the small sample size, this study demonstrated the diagnostic utility, high sensitivity, and positive predictive value of CK20/p53 DIC, especially in cases with a small number of single malignant cells or cellular clusters of reactive atypical urothelial cells. Thus, CK20/p53 DIC can be used for improving diagnostic accuracy of UC, either as an ancillary method to cytology or as a part of a potential future diagnostic panel to improve patient diagnosis and management.
在液基细胞学中，细胞角蛋白（CK）20和p53的双重免疫细胞化学（DIC）是提高尿液细胞学（UC）准确性的一种工具。本研究旨在比较单纯UC与联合CK20/p53 DIC的诊断准确性。
我们检索了2015年1月至2016年3月间收集的、保存在PreservCyt®溶液中的尿液样本，这些样本来自被分类为恶性、高度可疑、可疑和非典型的病例，并与随后的活检结果相匹配。我们重新制备了28例患者的63份样本用于DIC，并对63对原始巴氏涂片和DIC进行了盲法评估。
63份样本中，有11份因非典型尿路上皮细胞数量过少而无法分析，其余52份样本的结果如下：34份阳性，18份阴性。DIC的阳性预测值为100%，阴性预测值为78%。15例经组织学证实为恶性的DIC阳性病例，最初被诊断为高度可疑（4例）、可疑（8例）和非典型（3例），强烈提示为“尿路上皮癌”。4例经组织学证实为非肿瘤性病例的阴性病例，从假阳性中被筛选出来。
尽管样本量较小，但本研究证明了CK20/p53 DIC的诊断效用、高敏感性和阳性预测值，特别是在有少量单个恶性细胞或反应性非典型尿路上皮细胞细胞簇的病例中。因此，CK20/p53 DIC可作为细胞学的辅助方法或未来潜在诊断组合的一部分，用于提高UC的诊断准确性，从而改善患者的诊断和管理。
