Department of Urology, Osaka Rosai Hospital, Nagasone-cho 1179-3, Kitaku, Sakaishi, Osaka, Japan.
Department of Laboratory Medicine, Osaka Rosai Hospital, Osaka, Japan.
Int J Clin Oncol. 2019 Sep;24(9):1075-1080. doi: 10.1007/s10147-019-01447-5. Epub 2019 Apr 11.
In general, urine cytology is often problematic because of its low sensitivity, especially for low-grade urothelial carcinoma (UC) in clinical practice. To improve the sensitivity, we focused on 5-aminolevulinic acid (5-ALA), because recent studies suggested that 5-ALA-induced urine cytology can be used for photodynamic diagnosis. In this study, we evaluated the diagnostic efficacy of 5-ALA-induced fluorescent urine cytology for UC.
We included in this study 318 patients comprising 158 non-cancer patients, 84 bladder tumor patients, and 76 upper urinary tract urothelial carcinoma (UUT-UC) patients treated in our institution from March 2013 to September 2018. Using the same voided urine sample, we compared sensitivity and specificity between conventional urine cytology and 5-ALA-induced fluorescent urine cytology.
Overall, the sensitivity of 5-ALA-induced fluorescent urine cytology was significantly higher than that of conventional urine cytology (86.9% vs. 69.4%; p = 0.0002), and the specificity was equivalently high (96.2% vs. 95.6%; p = 1.0). In subgroup analysis, the high sensitivity of 5-ALA-induced fluorescent urine cytology was also detected regardless of age, sex, and tumor type. However, in terms of stage and grade, differences were only detected in patients with less than pTa stage (89.2% vs. 52.1%; p = 0.0001) and low-grade tumor (91.5% vs. 51.1%; p < 0.0001).
5-ALA-induced fluorescent urine cytology was significantly more effective for UC diagnosis when compared with the conventional cytology, especially in patients with low-stage and low-grade tumors. These findings indicate that 5-ALA-induced fluorescent urine cytology may potentially be a very useful tool for clinical use.
一般来说，尿液细胞学检查由于其敏感性低，特别是在临床实践中对于低级别尿路上皮癌（UC），往往存在问题。为了提高敏感性，我们专注于 5-氨基酮戊酸（5-ALA），因为最近的研究表明，5-ALA 诱导的尿液细胞学检查可用于光动力诊断。在这项研究中，我们评估了 5-ALA 诱导的荧光尿液细胞学检查对 UC 的诊断效果。
我们纳入了 2013 年 3 月至 2018 年 9 月在我院治疗的 318 例患者，包括 158 例非癌症患者、84 例膀胱肿瘤患者和 76 例上尿路尿路上皮癌（UUT-UC）患者。使用相同的尿液样本，我们比较了常规尿液细胞学检查和 5-ALA 诱导的荧光尿液细胞学检查的敏感性和特异性。
总体而言，5-ALA 诱导的荧光尿液细胞学检查的敏感性明显高于常规尿液细胞学检查（86.9% vs. 69.4%；p=0.0002），特异性也相当高（96.2% vs. 95.6%；p=1.0）。在亚组分析中，无论年龄、性别和肿瘤类型，5-ALA 诱导的荧光尿液细胞学检查的高敏感性也得以检测。然而，在分期和分级方面，仅在 pTa 期以下（89.2% vs. 52.1%；p=0.0001）和低级别肿瘤（91.5% vs. 51.1%；p<0.0001）患者中检测到差异。
与常规细胞学检查相比，5-ALA 诱导的荧光尿液细胞学检查对 UC 诊断更为有效，特别是在低分期和低分级肿瘤患者中。这些发现表明，5-ALA 诱导的荧光尿液细胞学检查可能是一种非常有用的临床工具。
