Ho K J, Kuo S H
Department of Laboratory Medicine, National Taiwan University, Medical College, Taipei.
Cancer. 1995 Aug 1;76(3):473-8. doi: 10.1002/1097-0142(19950801)76:3<473::aid-cncr2820760318>3.0.co;2-6.
Routine urine cytology is not particularly useful as a screening test for urinary tract malignancy in the general population, due to its low detection rate. Bladder, ureteral, and pelvic lavage and flow cytometry increased the test sensitivity but could be applied only to a limited number of patients. A simple, sensitive screening test is needed.
Two hundred eighty-two urine samples from 146 patients from the Urology Tumor Clinic patients during their initial visits were subject to cytologic evaluation and measurement of the activity of endogenous beta-glucuronidase, followed by confirmation procedures, including cystoscopy with biopsy, ultrasonography, radiography and/or computed tomography.
Among 146 patients, 32 had confirmed transitional cell carcinoma and 14 renal cell carcinoma. The urinary beta-glucuronidase activity was higher in patients with cancer than in those without cancer in the Urology Service and in 80 normal healthy control subjects. The accuracy of the urine enzyme diagnostic system measured by the receiver-operating characteristic (ROC) plot was 98% or higher based on the number of patients. The upper threshold value determined by ROC analysis was 1.7 nmol/min/mumol creatinine. At this threshold value, the sensitivities of the enzyme assay for transitional cell carcinoma, renal cell carcinoma, and all cancers were, respectively, 94%, 98%, and 95%. These values were much higher than the corresponding sensitivities of urine cytology: 41%, 0%, and 22%.
Urinary beta-glucuronidase is a much more sensitive test to screen for urinary tract malignancy than routine urine cytology in high risk patients, provided that a positive test is followed by diagnostic procedures for confirmation.
由于常规尿细胞学检查的检出率较低，因此在普通人群中作为尿路恶性肿瘤的筛查试验并不是特别有用。膀胱、输尿管和盆腔灌洗及流式细胞术提高了检测敏感性，但仅适用于有限数量的患者。需要一种简单、灵敏的筛查试验。
对泌尿外科肿瘤门诊146例患者初次就诊时的282份尿液样本进行细胞学评估和内源性β-葡萄糖醛酸酶活性测定，随后进行包括膀胱镜活检、超声、放射摄影和/或计算机断层扫描在内的确诊程序。
146例患者中，32例确诊为移行细胞癌，14例为肾细胞癌。泌尿外科患者及80名正常健康对照者中，癌症患者尿β-葡萄糖醛酸酶活性高于非癌症患者。根据患者数量，通过受试者操作特征（ROC）曲线测得的尿酶诊断系统的准确率为98%或更高。ROC分析确定的上限值为1.7 nmol/分钟/微摩尔肌酐。在此阈值下，酶测定对移行细胞癌、肾细胞癌和所有癌症的敏感性分别为94%、98%和95%。这些值远高于尿细胞学相应的敏感性：41%、0%和22%。
对于高危患者，尿β-葡萄糖醛酸酶作为筛查尿路恶性肿瘤的试验比常规尿细胞学检查更为敏感，前提是阳性试验后需进行确诊的诊断程序。
