Tang Cheuk-Yin, Li Joshua J X, Leung Ka Long, Ma Hei Yuet, Ng Joanna K M, Yan Ryan T L, Teoh Jeremy Y, VandenBussche Christopher J, Tse Gary M
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
Prostate. 2025 Jan;85(1):97-104. doi: 10.1002/pros.24805. Epub 2024 Oct 14.
Urine cytology is robust for the diagnosis of urothelial lesions, but data on the detection rates of prostatic adenocarcinoma in urine cytology is limited. In this study, a multicenter review was performed to define the clinical role of urine cytology in diagnosis of prostatic adenocarcinoma.
Cytologic diagnoses of lower tract urine cytology specimens with histology-proven prostatic adenocarcinoma from three institutions, from a period of over two decades, were reviewed. Clinicopathological parameters-tumor grade, stage, histologic features, and preanalytical factors-prostate-specific antigen (PSA) level and lesion size, were retrieved and compared with cytologic diagnoses.
In total, 2115 urine cytology specimens from 1119 patients were retrieved. The atypia (or above/C3+) and suspicious (or above/C4+) rates were 19.48% and 3.36%. Bilobar and extracapsular involvement, lymphovascular invasion, Gleason score, and International Society of Urological Pathology grade were associated with a positive urine diagnosis (p < 0.05). The atypia (C3+) and suspicious (C4+) rates of urine cytology in patients with a PSA level of ≤4.0 ng/mL was paradoxically higher (p < 0.01), but PSA levels correlated positively with urine diagnosis at higher cutoffs (>10, >20, >50, >100 ng/mL). All these factors remained significant on multivariate analysis (p < 0.05), including a negative correlation with low-PSA (≤4.0 ng/mL, p = 0.001) and positive correlation with high-PSA (>20 ng/mL, p = 0.020). Lesion size and multifocality were not associated with urine cytology diagnosis (p > 0.05).
Urine cytology showed low sensitivity in detection of prostatic adenocarcinoma. Detection rates were largely positively correlated with PSA levels but not for lesion size nor multifocality, limiting its clinical utility.
尿细胞学检查对尿路上皮病变的诊断具有重要意义，但关于尿细胞学检查对前列腺腺癌的检出率的数据有限。在本研究中，我们进行了一项多中心回顾性研究，以明确尿细胞学检查在前列腺腺癌诊断中的临床作用。
回顾了来自三个机构的、经组织学证实为前列腺腺癌的下尿路尿细胞学标本的细胞学诊断，时间跨度超过二十年。收集临床病理参数——肿瘤分级、分期、组织学特征以及分析前因素——前列腺特异性抗原（PSA）水平和病变大小，并与细胞学诊断结果进行比较。
共检索到1119例患者的2115份尿细胞学标本。非典型性（或以上/C3+）和可疑（或以上/C4+）率分别为19.48%和3.36%。双侧叶及包膜外侵犯、淋巴管浸润、Gleason评分和国际泌尿病理学会分级与尿诊断阳性相关（p < 0.05）。PSA水平≤4.0 ng/mL的患者尿细胞学检查的非典型性（C3+）和可疑（C4+）率反而更高（p < 0.01），但在更高的临界值（>10、>20、>50、>100 ng/mL）时，PSA水平与尿诊断呈正相关。在多因素分析中，所有这些因素均具有显著性（p < 0.05），包括与低PSA（≤4.0 ng/mL）呈负相关（p = 0.001）以及与高PSA（>20 ng/mL）呈正相关（p = 0.020）。病变大小和多灶性与尿细胞学诊断无关（p > 0.05）。
尿细胞学检查对前列腺腺癌的检测敏感性较低。检出率在很大程度上与PSA水平呈正相关，但与病变大小和多灶性无关，限制了其临床应用价值。
