Institute of Pathology, Università Cattolica del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, Italy.
Institute of Pathology, Università Cattolica del S. Cuore, Fondazione Policlinico "A. Gemelli", Rome, Italy.
Urol Oncol. 2021 Feb;39(2):131.e17-131.e21. doi: 10.1016/j.urolonc.2020.06.018. Epub 2020 Aug 7.
To identify in which cases after cytological diagnosis, the Bladder EpiCheck test could represent an effective tool in non-muscle invasive bladder carcinoma or an useless expence.
375 patients diagnosed with non-muscle invasive bladder cancer, 269 with high grade urothelial carcinoma and 106 with carcinoma in situ, were treated and followed for 1 year. The treatment was an intravesical instillation of Bacillus Calmette-Guerin in 305 patients and Mitomycin-C in 70 patients. During the follow-up patients were evaluated by voided urine cytology and white-light cystoscopy, according to the European Association of Urology Guidelines. Bladder EpiCheck test was performed together with cytology in all cases.
Analyzing Bladder Epicheck results for each category defined by the Paris System for Reporting Urinary Cytology, we found that the Episcore >60 correlates with histological diagnosis of high grade urothelial carcinoma (HGUC) in atypical urothelial cells and Suspicious for High Grade Urothelial Carcinoma (P = 0.0002 Odds Ratio 0.05926 95% Confidence Interval from 0.01127 to 0.3116 and P = 0.0009 Odds Ratio 0.03155 95% Confidence Interval from 0.001683 to 0.5914, Fisher's exact test, respectively), while in Negative for high grade urothelial carcinoma and HGUC patients Episcore is not helpful to identify cases with histological diagnosis of HGUC (P = 0.101 and P = 0.58 Fisher's exact test, respectively). Considering an Episcore ≥ 90 in the HGUC cytological group, this seems not to be correlated with a histological diagnosis of HGUC (P = 0.090 Fisher's exact test).
Cytology and Bladder EpiCheck test in combination may have the potential to reduce cystoscopies in the follow-up of non-muscle invasive bladder cancer only for cytological diagnoses of atypical urothelial cells and Suspicious for High Grade Urothelial Carcinoma . Moreover, in patients with a cytological diagnosis of Negative for high grade urothelial carcinoma or HGUC, cytology alone seems to be safe and cost-effective.
确定在细胞学诊断后，膀胱 EpiCheck 检测在非肌肉浸润性膀胱癌中是一种有效的工具，还是一种无用的花费。
对 375 例非肌肉浸润性膀胱癌患者进行了治疗和随访 1 年。其中 269 例为高级别尿路上皮癌，106 例为原位癌。305 例患者接受膀胱内卡介苗灌注治疗，70 例患者接受丝裂霉素 C 治疗。根据欧洲泌尿外科学会指南，在随访期间，通过尿脱落细胞学和白光膀胱镜检查对患者进行评估。所有患者均同时进行膀胱 EpiCheck 检测和细胞学检查。
分析按巴黎泌尿系统细胞学报告系统分类的膀胱 EpiCheck 结果，我们发现 Episcore >60 与非典型尿路上皮细胞中高级别尿路上皮癌（HGUC）的组织学诊断相关（可疑高级别尿路上皮癌，P=0.0002 优势比 0.05926 95%置信区间为 0.01127 至 0.3116 和 P=0.0009 优势比 0.03155 95%置信区间为 0.001683 至 0.5914，Fisher 精确检验），而在高级别尿路上皮癌和 HGUC 患者的阴性结果中，Episcore 无助于识别组织学诊断为 HGUC 的病例（P=0.101 和 P=0.58 Fisher 精确检验）。考虑到 HGUC 细胞学组中的 Episcore ≥90，这似乎与 HGUC 的组织学诊断无关（P=0.090 Fisher 精确检验）。
细胞学和膀胱 EpiCheck 联合检测可能有潜力减少非肌肉浸润性膀胱癌的随访中膀胱镜检查的次数，仅适用于非典型尿路上皮细胞和可疑高级别尿路上皮癌的细胞学诊断。此外，在细胞学诊断为高级别尿路上皮癌或 HGUC 阴性的患者中，单独进行细胞学检查似乎是安全且具有成本效益的。
