Giudici Nicola, Blarer Jennifer, Sathianathen Niranjan, Burkhard Fiona C, Wuethrich Patrick Y, Thalmann George N, Seiler Roland, Furrer Marc A
Department of Urology, Hospital Center Biel, Vogelsang 84, 2501 Biel, Switzerland.
Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3052, Australia.
Cancers (Basel). 2024 Feb 12;16(4):758. doi: 10.3390/cancers16040758.
We performed a urine cytology analysis of a pharmacologically induced diuresis for the diagnosis of upper tract urothelial carcinoma. To evaluate the diagnostic value of cytology of pharmacologically forced diuresis, an initial cohort of 77 consecutive patients with primary upper tract urothelial carcinoma treated via radical surgery was enrolled. To evaluate pharmacologically forced diuresis cytology as a follow-up procedure, a second cohort of 1250 patients who underwent a radical cystectomy for bladder cancer was selected. In the first cohort, the sensitivity of cytology of pharmacologically forced diuresis in patients with invasive, high-grade, low-grade, and concomitant carcinoma in situ was 8%, 9%, 0%, and 14%, respectively. In the second cohort, cytology of pharmacologically forced diuresis was positive in 30/689 (4.3%) patients, in whom upper urinary tract recurrence was present in 21/30 (70%) of cases, and urethral recurrence was present in 8/30 (26%) of cases. As a follow-up tool, cytology of pharmacologically forced diuresis showed a sensitivity, specificity, and positive and negative predictive values of 60%, 99%, 70%, and 98%, respectively. Overall, as a diagnostic tool, the sensitivity of cytology of pharmacologically forced diuresis is slightly better in patients with invasive upper tract urothelial carcinoma and concomitant carcinoma in situ. As a follow-up method, positive cytology of pharmacologically forced diuresis is strongly related to cancer recurrence and can reveal urethral recurrence. Cytology of pharmacologically forced diuresis might be useful in cases with contraindications for imaging or when achieving endoscopic access to the upper urinary tract is difficult.
我们对药物诱导利尿进行了尿液细胞学分析，以诊断上尿路尿路上皮癌。为评估药物强制利尿细胞学的诊断价值，纳入了首批77例经根治性手术治疗的原发性上尿路尿路上皮癌患者。为评估药物强制利尿细胞学作为一种随访程序的价值，选择了第二批1250例因膀胱癌接受根治性膀胱切除术的患者。在首批队列中，药物强制利尿细胞学对浸润性、高级别、低级别及原位癌伴发癌患者的敏感性分别为8%、9%、0%和14%。在第二批队列中，药物强制利尿细胞学在30/689（4.3%）的患者中呈阳性，其中21/30（70%）的病例存在上尿路复发，8/30（26%）的病例存在尿道复发。作为一种随访工具，药物强制利尿细胞学的敏感性、特异性、阳性预测值和阴性预测值分别为60%、99%、70%和98%。总体而言，作为一种诊断工具，药物强制利尿细胞学在浸润性上尿路尿路上皮癌和原位癌伴发癌患者中的敏感性略高。作为一种随访方法，药物强制利尿细胞学阳性与癌症复发密切相关，且可发现尿道复发。药物强制利尿细胞学在存在影像学检查禁忌证或难以对上尿路进行内镜检查的情况下可能有用。
