Gourlay W, Chan V, Gilks C B
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Mod Pathol. 1995 May;8(4):394-7.
A prospective study was initiated to compare the ability of flow cytometry and cytologic analysis to detect malignant cells in urine obtained at the time of cystoscopy. The population studied consisted of patients from general urologic practices who were undergoing cystoscopy in a single community hospital. Over a 1-yr period, 335 specimens from 317 patients were studied. Nineteen biopsy-proven urothelial malignancies were identified. Cytologic examination of urine obtained at the time of cystoscopy was positive in seven of these cases, and an aneuploid population of cells was identified by flow cytometry in three cases. All three cases of high-grade transitional cell carcinoma and carcinoma in situ were correctly identified by the combination of cytologic examination and flow cytometry; however, only four of 16 low-grade superficial papillary transitional cell carcinomas were recognized cytologically, with only one being aneuploid. The combination of cytologic analysis and flow cytometry did not increase the diagnostic sensitivity above that achieved with cytologic testing alone (overall sensitivity, 37%). We conclude that flow cytometry and cytologic analysis, either individually or in combination, are too insensitive for use in a routine screening program for urothelial malignancy in a community hospital setting because of the inability of either method to detect low-grade transitional cell carcinomas reliably.
一项前瞻性研究启动，旨在比较流式细胞术和细胞学分析检测膀胱镜检查时所取尿液中恶性细胞的能力。研究人群包括在一家社区医院接受膀胱镜检查的普通泌尿外科患者。在1年的时间里，对317例患者的335份标本进行了研究。确定了19例经活检证实的尿路上皮恶性肿瘤。膀胱镜检查时所取尿液的细胞学检查在其中7例中呈阳性，流式细胞术在3例中鉴定出非整倍体细胞群。通过细胞学检查和流式细胞术的联合检测，所有3例高级别移行细胞癌和原位癌均被正确识别；然而，16例低级别浅表乳头状移行细胞癌中，细胞学仅识别出4例，其中只有1例为非整倍体。细胞学分析和流式细胞术的联合检测并未使诊断敏感性高于单独进行细胞学检测时的水平（总体敏感性为37%）。我们得出结论，由于两种方法都无法可靠地检测低级别移行细胞癌，因此在社区医院环境中，流式细胞术和细胞学分析单独或联合使用时，对尿路上皮恶性肿瘤的常规筛查程序来说敏感性都太低。
