de la Roza G L, Hopkovitz A, Caraway N P, Kidd L, Dinney C P, Johnston D, Katz R L
Department of Pathology, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA.
Mod Pathol. 1996 May;9(5):571-8.
To evaluate the utility of image analysis in monitoring patients with transitional cell carcinoma, we studied, by cytologic means and by image analysis, 78 urinary tract specimens from 66 patients, of whom 49 (74%) had a previous history of transitional cell carcinoma. The specimens consisted of 51 (65%) voided urine specimens, 12 (15%) bladder washings, 8 (10%) ureteral washings, 3 (4%) ureteral brushings, 2 (3%) renal pelvic washings, and 2 (3%) catheterized urine specimens. DNA histograms were classified into five patterns on the basis of their DNA index and the percentage of their cells with DNA content greater than 5c: diploid (single peak in the 2c region with no cells greater than 5c), intermediate (diploid with less than 10% of cells greater than 5c), aneuploid (single peak or multiple peaks between the 2c and 4c region or more than 10% of cells greater than 5c), tetraploid (at least 10% of cells in the 4c region and a corresponding peak at 8c), and polyploid (multiple peaks in the 2c, 4c, 8c, and 10c regions). Of the 78 cases, 22 were diploid, 24 were intermediate, 29 were aneuploid, one was tetraploid, and two were polyploid. Histologic confirmation or clinical follow-up was found in 29 aneuploid cases, 13 intermediate cases, and one diploid case. Most cases of carcinoma in situ (five of six) and invasive tumors (12 of 17) were aneuploid. The sensitivity was 100%, and the specificity was 73% when cytologic and image analysis results were combined. We conclude that image analysis, when combined with cytologic examination, is a reliable noninvasive diagnostic test for monitoring patients with transitional cell carcinoma; aneuploidy is specific for malignancy; and the presence of cells greater than 5c, although frequently associated with tumor recurrence, can be seen in non-neoplastic conditions.
为评估图像分析在监测移行细胞癌患者中的效用，我们通过细胞学方法和图像分析研究了66例患者的78份尿路标本，其中49例（74%）有移行细胞癌病史。标本包括51份（65%）晨尿标本、12份（15%）膀胱冲洗液、8份（10%）输尿管冲洗液、3份（4%）输尿管刷检物、2份（3%）肾盂冲洗液和2份（3%）导尿标本。DNA直方图根据其DNA指数及其DNA含量大于5c的细胞百分比分为五种模式：二倍体（2c区域单峰，无细胞大于5c）、中间型（二倍体，小于10%的细胞大于5c）、非整倍体（2c和4c区域之间单峰或多峰，或超过10%的细胞大于5c）、四倍体（至少10%的细胞在4c区域，8c处有相应峰）和多倍体（2c、4c、8c和10c区域多峰）。78例中，22例为二倍体，24例为中间型，29例为非整倍体，1例为四倍体，2例为多倍体。在29例非整倍体病例、13例中间型病例和1例二倍体病例中发现了组织学确诊或临床随访结果。大多数原位癌病例（6例中的5例）和浸润性肿瘤（17例中的12例）为非整倍体。当细胞学和图像分析结果结合时，敏感性为100%，特异性为73%。我们得出结论，图像分析与细胞学检查相结合时，是监测移行细胞癌患者的可靠非侵入性诊断试验；非整倍体对恶性肿瘤具有特异性；大于5c的细胞的存在虽然常与肿瘤复发相关，但在非肿瘤性疾病中也可见到。
