Golijanin D, Sherman Y, Shapiro A, Pode D
Department of Urology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
Urology. 1995 Aug;46(2):173-7. doi: 10.1016/s0090-4295(99)80189-7.
A study was made to determine the sensitivity and specificity of immunostaining of the Lewis X antigen in exfoliated urothelial cells from voided urine, for the detection and surveillance of bladder tumors.
Three consecutive voided urine specimens were obtained from 101 patients, 78 of whom were under surveillance because of a history of bladder tumors, and 23 were being evaluated because of hematuria or irritative urinary symptoms. Indirect immunoperoxidase staining of two urine samples was done on cytocentrifuge slides, using the P12 monoclonal antibody against the Lewis X antigen. The diagnosis of the presence of urothelial tumor was made if more than 5% of the cells showed a typical red-brown staining. Cytopathologic examination of the third urine specimen was done according to Papanicolaou. Each patient underwent cystoscopy, and biopsies were obtained whenever there was endoscopic evidence of bladder tumors or carcinoma in situ.
Cystoscopy and biopsies revealed transitional cell carcinoma in 32 patients, whereas 69 patients had no evidence of bladder tumors. Immunocytology of one urine sample showed true-positive results in 26 of the 32 patients with bladder tumors, corresponding to a sensitivity of 81.25%. When two samples were examined, a sensitivity of 97% and a specificity of 85.5% were obtained. When the results of cytology and immunocytology were combined, sensitivity reached 100%. High-grade and low-grade transitional cell tumors were detected with equal efficiency.
The use of P12 monoclonal antibody for evaluation of Lewis X reactivity in cytologic preparations from multiple voided urine specimens can improve the sensitivity of noninvasive detection of bladder cancer. The technique may ultimately replace cystoscopy in monitoring therapeutic response and tumor recurrence.
开展一项研究以确定尿脱落尿路上皮细胞中Lewis X抗原免疫染色对于膀胱肿瘤检测和监测的敏感性和特异性。
从101例患者中获取连续3份晨尿样本，其中78例因膀胱肿瘤病史接受监测，23例因血尿或尿路刺激症状接受评估。使用抗Lewis X抗原的P12单克隆抗体，在细胞离心涂片上对两份尿液样本进行间接免疫过氧化物酶染色。如果超过5%的细胞显示典型的红棕色染色，则诊断为存在尿路上皮肿瘤。根据巴氏染色法对第三份尿液标本进行细胞病理学检查。每位患者均接受膀胱镜检查，只要内镜检查有膀胱肿瘤或原位癌的证据，就进行活检。
膀胱镜检查和活检显示32例患者患有移行细胞癌，而69例患者没有膀胱肿瘤的证据。一份尿液样本的免疫细胞学检查在32例膀胱肿瘤患者中的26例显示真阳性结果，敏感性为81.25%。检查两份样本时，敏感性为97%，特异性为85.5%。当细胞学和免疫细胞学结果相结合时，敏感性达到100%。高级别和低级别移行细胞肿瘤的检测效率相同。
使用P12单克隆抗体评估多份晨尿标本细胞学制剂中Lewis X反应性可提高膀胱癌无创检测的敏感性。该技术最终可能会取代膀胱镜检查来监测治疗反应和肿瘤复发。
