Cho Eun-Jung, Kwon Bang Chang, Kim Hyunjung, Kyung Lee Hae
Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Department of Laboratory Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
J Clin Lab Anal. 2020 Aug;34(8):e23345. doi: 10.1002/jcla.23345. Epub 2020 Jul 10.
Bladder cancer is the eighth most common cancer and the second most common urological cancer in Korean males. Current diagnostic tools for bladder cancer include cystoscopy (an upper tract study), urine cytology, and nuclear matrix protein 22 (NMP22) test. In this study, we evaluated the detection rate of atypical/malignant urothelial cells in urinary sediment images when flagged for positive NMP22 test.
NMP22 was measured by NMP22 BladderChek Test (Abbott Laboratories) and urine chemical and sediment analysis were performed by fully automated cobas 6500 urine analyzer (Roche Diagnostics). Specimens that met the manual microscopic examination (MME) criteria were then subjected to an on-screen review of images. We subsequently reviewed sediment images and examined under the microscopy for the flagged cases.
Of the 1217 patients, 345 (28.3%) had positive NMP22 results, whereas 872 (71.7%) had negative results. Out of the positive results, 154 (12.7%) were positive and 191 (15.7%) weakly positive for NMP22. Screened review of flagged specimens (ie, positive NMP22 result) with sediment imaging analysis revealed that suspicious urothelial carcinoma cells were detected in only two cases (0.8%). In the NMP22 negative flagged cases, the suspicious neoplastic cells were not found.
Our findings suggest that the NMP22 test should be added to the flagging criteria for MME to improve diagnostic accuracy. The combination of urine sediment imaging analysis and NMP22 test can significantly assist technicians in the review of specimens.
膀胱癌是韩国男性中第八大常见癌症和第二大常见泌尿系统癌症。目前膀胱癌的诊断工具包括膀胱镜检查（上尿路检查）、尿液细胞学检查和核基质蛋白22（NMP22）检测。在本研究中，我们评估了NMP22检测呈阳性时尿沉渣图像中非典型/恶性尿路上皮细胞的检出率。
采用NMP22 BladderChek检测（雅培实验室）测定NMP22，并使用全自动cobas 6500尿液分析仪（罗氏诊断）进行尿液化学和沉渣分析。符合手工显微镜检查（MME）标准的标本随后进行图像屏幕审查。我们随后审查了沉渣图像，并在显微镜下检查标记的病例。
在1217例患者中，345例（28.3%）NMP22检测结果为阳性，而872例（71.7%）为阴性。在阳性结果中，154例（12.7%）NMP22呈阳性，191例（15.7%）呈弱阳性。对标记标本（即NMP22检测结果为阳性）进行沉渣成像分析的筛查审查显示，仅在两例（0.8%）中检测到可疑的尿路上皮癌细胞。在NMP22阴性标记的病例中，未发现可疑的肿瘤细胞。
我们的研究结果表明，应将NMP22检测添加到MME的标记标准中，以提高诊断准确性。尿沉渣成像分析和NMP22检测相结合可以显著帮助技术人员审查标本。
