Murphy W M, Soloway M S, Jukkola A F, Crabtree W N, Ford K S
Cancer. 1984 Apr 1;53(7):1555-65. doi: 10.1002/1097-0142(19840401)53:7<1555::aid-cncr2820530723>3.0.co;2-g.
Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow-up of patients with bladder cancer. Its potential value has been reduced, however, by the relative inexperience of most pathologists in the examination of urinary specimens, and by the lack of cellular criteria specifically reflecting the morphology of low-grade papillary and flat lesions of bladder epithelium. The cytologic features of urothelial lesions, including papillary transitional cell carcinomas and flat urothelial dysplasias have been studied in both experimental systems and clinical situations and their application to a selected patient population is presented. Overall, the cytohistologic correlation for patients with bladder cancer was 92%. Positive cells reflecting the morphology of the tumor occurred in 62% of patients with grade I transitional cell carcinomas, and cells suspicious for malignancy were identified in an additional 14% of these individuals. Using the criteria presented, a positive cytology can correlate with a papillary grade I bladder tumor, and should not necessarily indicate the presence of another neoplasm. Dysplastic cells in cytologic specimens are often identified in patients having urothelial dysplasia as the most serious bladder lesion, but the cytologic diagnosis of dysplasia may represent an under-interpretation of a low-grade papillary bladder tumor. The cells of urothelial neoplasms, including low-grade transitional cell carcinomas and dysplasias, differ morphologically both from normal and reactive/reparative elements, and can be detected in cytologic samples. The changes are often subtle and require experience and a cautious approach for accurate interpretation.
尿细胞学检查作为膀胱癌患者检测及随访的诊断工具，越来越被广泛接受。然而，由于大多数病理学家在尿标本检查方面相对缺乏经验，以及缺乏专门反映膀胱上皮低级别乳头状和平坦病变形态的细胞标准，其潜在价值有所降低。本文对包括乳头状移行细胞癌和平坦尿路上皮发育异常在内的尿路上皮病变的细胞学特征在实验系统和临床情况下均进行了研究，并介绍了其在特定患者群体中的应用。总体而言，膀胱癌患者的细胞组织学相关性为92%。反映肿瘤形态的阳性细胞出现在62%的I级移行细胞癌患者中，另外14%的此类患者中发现了可疑恶性细胞。根据所提出的标准，阳性细胞学结果可与I级乳头状膀胱肿瘤相关，不一定表明存在其他肿瘤。在以尿路上皮发育异常为最严重膀胱病变的患者的细胞学标本中，常可识别出发育异常细胞，但发育异常的细胞学诊断可能代表对低级别乳头状膀胱肿瘤的解读不足。尿路上皮肿瘤的细胞，包括低级别移行细胞癌和发育异常，在形态上既不同于正常细胞，也不同于反应性/修复性细胞成分，可在细胞学样本中检测到。这些变化往往很细微，需要经验和谨慎的方法才能准确解读。
