Pan Tommy, Lehman Erik, Raman Jay D
Penn State College of Medicine, Hershey PA 17033, USA.
Penn State Health Milton S. Hershey Medical Center, Hershey PA 17033, USA.
Am J Clin Exp Urol. 2021 Oct 15;9(5):384-389. eCollection 2021.
Hematuria investigations presently entail cystoscopy with upper urinary tract imaging albeit without use of urinary biomarkers including cytology. The purpose is to investigate the performance characteristics of urinary cytology in a population of patients presenting with gross (GH) and microscopic (MH) hematuria.
Records for 409 consecutive patients undergoing a complete hematuria evaluation (cystoscopy with upper-tract imaging) who also had urinary cytology were reviewed. Performance characteristics (sensitivity, specificity, PPV, NPV) of cytology for urothelial malignancy were determined. For those with urothelial cancer, the predictive value of a positive cytology for high grade and high stage urothelial cancer was determined.
29 of 409 patients (7.1%) were diagnosed with urothelial carcinoma including 24 (9.2%) and 5 (3.4%) from the GH and MH populations, respectively. Eighteen (62%) of these tumors were high grade of which 5 (28%) were muscle-invasive. The performance characteristics of cytology for urothelial malignancy included a sensitivity of 41%, specificity of 99%, PPV of 75%, NPV of 96%, and diagnostic accuracy of 95%. No observed differences were noted when comparing gender (P=0.55), type of hematuria (P=0.37), or smoking history (P=0.22). For those diagnosed with urothelial malignancy, a positive cytology was not associated with higher grade (P=1.0) or stage tumors (P=0.62).
Urine cytology had low sensitivity and PPV for urothelial carcinoma irrespective of smoker status, hematuria type, or gender. These data support the 2020 AUA Microhematuria Guideline emphasizing that urine cytology should not routinely be used in a hematuria screening population.
目前血尿检查需要进行膀胱镜检查及上尿路成像，尽管未使用包括细胞学在内的尿液生物标志物。目的是研究尿细胞学在肉眼血尿（GH）和镜下血尿（MH）患者群体中的性能特征。
回顾了409例连续接受完整血尿评估（膀胱镜检查及上尿路成像）且同时进行了尿细胞学检查的患者记录。确定了尿细胞学对上尿路上皮恶性肿瘤的性能特征（敏感性、特异性、阳性预测值、阴性预测值）。对于那些患有尿路上皮癌的患者，确定了阳性细胞学检查对高级别和高分期尿路上皮癌的预测价值。
409例患者中有29例（7.1%）被诊断为尿路上皮癌，其中GH组有24例（9.2%），MH组有5例（3.4%）。这些肿瘤中有18例（62%）为高级别，其中5例（28%）为肌层浸润性。尿细胞学对上尿路上皮恶性肿瘤的性能特征包括敏感性为41%、特异性为99%、阳性预测值为75%、阴性预测值为96%以及诊断准确性为95%。在比较性别（P=0.55）、血尿类型（P=0.37）或吸烟史（P=0.22）时未观察到差异。对于那些被诊断为尿路上皮恶性肿瘤的患者，阳性细胞学检查与肿瘤的高级别（P=1.0）或分期（P=0.62）无关。
无论吸烟者状态、血尿类型或性别如何，尿细胞学对上尿路上皮癌的敏感性和阳性预测值都较低。这些数据支持2020年美国泌尿外科学会（AUA）微血尿指南强调的观点，即尿细胞学不应常规用于血尿筛查人群。
