膀胱超声检查与尿细胞诊断相结合能否替代膀胱镜用于膀胱肿瘤的诊断及随访？

[Can the combination of bladder ultrasonography and urinary cytodiagnosis replace cystoscopy in the diagnosis and follow-up of tumors of the bladder?].

作者信息

Cariou G, Maaraoui N, Cortesse A

机构信息

Service d'Urologie, Hôpital des Diaconesses, Paris, France.

出版信息

Prog Urol. 1997 Feb;7(1):51-5.

PMID:9116739

Abstract

OBJECTIVES

Cystoscopy is currently the reference examination for the diagnosis and surveillance of bladder tumours (BT). However, this examination remains unpleasant for the patient, despite the development of flexible cystoscopes. Among the many diagnostic methods performed in combination with cystoscopy, the authors decided to evaluate the performances of the combination of ultrasonography+urine cytology in the diagnosis and follow-up of bladder tumours.

METHODS

This prospective study included 124 cases in the context of postoperative surveillance of BT (86) or aetiological assessment of haematuria (38). All patients were assessed by cystoscopy, suprapubic vesical ultrasonography, and urine cytology.

RESULT

Cystoscopy revealed a bladder tumour in 30 patients. Urine cytology had a sensitivity of 53% and a negative predictive value (NPV) of 86%. Vesical ultrasonography had a sensitivity of 50% and an NPV of 85%. The false-positive and false-negative results of ultrasonography and urine cytology make these examinations unreliable when considered separately. The combination of ultrasonography and urine cytology had an overall sensitivity of 80% and an NPV of 93%. However, analysis of the group of patients undergoing postoperative surveillance for BT showed that although the combination of the two examinations had a diagnostic sensitivity of 100% in the case of high-grade tumour or CIS, this value was only 66% for low-grade tumours. The authors review other methods of bladder tumour diagnosis, but none of them appears to have demonstrated a sufficient reliability at the present time.

CONCLUSION

The diagnostic sensitivity of the combination of ultrasonography and urine cytology, accurate but not recommended in high-risk patients with a high-grade BT, does not appear to be sufficient for systematic surveillance of patients with low-grade BT, despite the low risk of recurrence.

摘要

目的

膀胱镜检查目前是诊断和监测膀胱肿瘤（BT）的参考检查方法。然而，尽管软性膀胱镜有所发展，但该检查对患者来说仍然不太舒适。在与膀胱镜检查联合使用的众多诊断方法中，作者决定评估超声检查+尿液细胞学检查联合在膀胱肿瘤诊断和随访中的性能。

方法

这项前瞻性研究纳入了124例患者，其中86例为BT术后监测，38例为血尿病因评估。所有患者均接受膀胱镜检查、耻骨上膀胱超声检查和尿液细胞学检查。

结果

膀胱镜检查发现30例患者患有膀胱肿瘤。尿液细胞学检查的敏感性为53%，阴性预测值（NPV）为86%。膀胱超声检查的敏感性为50%，NPV为85%。超声检查和尿液细胞学检查的假阳性和假阴性结果使得单独考虑这些检查时不可靠。超声检查和尿液细胞学检查联合的总体敏感性为80%，NPV为93%。然而，对接受BT术后监测的患者组分析显示，尽管两种检查联合在高级别肿瘤或原位癌（CIS）的情况下诊断敏感性为100%，但对于低级别肿瘤，该值仅为66%。作者回顾了其他膀胱肿瘤诊断方法，但目前似乎没有一种方法显示出足够的可靠性。