Brisuda Antonín, Háček Jaromír, Čechová Marcela, Škapa Petr, Babjuk Marek
Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Cytopathology. 2019 Sep;30(5):510-518. doi: 10.1111/cyt.12698. Epub 2019 May 20.
Immunocytochemistry has attained a marginal role in urology so far. Combining the morphological and immunophenotypical changes of the urothelial cells retrieved from urine is a logical approach. The study aimed to analyse the diagnostic potential of immunocytological staining in the detection of high-grade and low-grade urothelial carcinoma.
Freshly voided urine was collected from 152 consecutive individuals, cytology classes were determined and cell blocks produced. A total of 77 patients were diagnosed with urothelial carcinoma and 75 patients had various benign urological conditions. Immunocytochemistry was performed using four antibodies: p53, MCM2, MCM5 and Ki-67. A diagnostic power to detect low grade and high-grade urothelial carcinoma was analysed for each antibody and their combinations with cytology.
There were no significant differences between patients with low-grade tumours and control group. Antibodies p53 and Ki-67 slightly improved the sensitivity of urinary cytology while maintaining its specificity. The best negative predictive value was demonstrated in combinations of cytology and MCM5 (88.9%) and cytology, p53 and MCM5 (90.6%). In the diagnosis of high-grade tumours, all antibodies apart from MCM2 yielded better sensitivity and specificity than cytology alone (receiver operating characteristic curves: p53 = 0.853, MCM5 = 0.931, and Ki-67 = 0.895). Combined with cytology, the sensitivities went even higher for the cost of lower specificity. The best diagnostic performance was observed in the combination of MCM5 and Ki-67 (sensitivity = 96.2%; specificity = 80%).
Immunocytochemistry with p53, MCM5 and Ki-67 antibodies can improve the diagnostic power of urinary cytology in the detection and follow-up of urinary bladder urothelial carcinoma.
免疫细胞化学在泌尿外科领域目前仅发挥着边缘作用。将从尿液中获取的尿路上皮细胞的形态学和免疫表型变化相结合是一种合理的方法。本研究旨在分析免疫细胞化学染色在检测高级别和低级别尿路上皮癌中的诊断潜力。
收集152例连续患者的新鲜晨尿，确定细胞学分级并制作细胞块。其中77例患者被诊断为尿路上皮癌，75例患者患有各种良性泌尿系统疾病。使用四种抗体进行免疫细胞化学检测：p53、MCM2、MCM5和Ki-67。分析每种抗体及其与细胞学联合检测低级别和高级别尿路上皮癌的诊断能力。
低级别肿瘤患者与对照组之间无显著差异。p53和Ki-67抗体在保持尿细胞学特异性的同时，略微提高了其敏感性。细胞学与MCM5联合（88.9%）以及细胞学、p53和MCM5联合（90.6%）显示出最佳的阴性预测值。在高级别肿瘤的诊断中，除MCM2外，所有抗体的敏感性和特异性均优于单独的细胞学检查（受试者工作特征曲线：p53 = 0.853，MCM5 = 0.931，Ki-67 = 0.895）。与细胞学联合时，敏感性更高，但特异性有所降低。MCM5和Ki-67联合显示出最佳的诊断性能（敏感性 = 96.2%；特异性 = 80%）。
使用p53、MCM5和Ki-67抗体的免疫细胞化学可提高尿细胞学在膀胱尿路上皮癌检测和随访中的诊断能力。
