Slaton J W, Dinney C P, Veltri R W, Miller C M, Liebert M, O'Dowd G J, Grossman H B
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
J Urol. 1997 Sep;158(3 Pt 1):806-11. doi: 10.1097/00005392-199709000-00030.
We determined whether deoxyribonucleic acid (DNA) ploidy analysis by image analysis cytometry enhances the cytological diagnosis of recurrent transitional cell carcinoma of the bladder.
A retrospective study was performed during a 5-year period to evaluate the cytological diagnosis and DNA ploidy analysis of 469 patients with previously diagnosed superficial transitional cell carcinoma. Cytological and DNA ploidy analysis was performed on 1,034 urine and bladder wash specimens, and the patients were monitored with cystoscopy and biopsies as clinically indicated. Cytology results were classified as normal, atypical, dysplastic or cancerous, and DNA ploidy was defined as normal if the diploid index was 1.2 or less, the S phase+G2M fraction was less than 21% or if there were 3% or less hyperploid cells, or abnormal if there was an increased S phase+G2M fraction, an aneuploid peak on the histogram or tetraploidy or hyperploidy was present.
The majority of patients (85 of 88, 97%) with a cytological diagnosis of cancer had an abnormal DNA ploidy, and in 60 of 85 of these patients (71%) recurrence was diagnosed within 6 months. Only 5 of 284 specimens (2%) with normal cytology had abnormal DNA ploidy and 1 of these 5 (20%) heralded transitional cell carcinoma recurrence. However, in 145 patients with atypical cytological findings 29 (20%) with abnormal DNA ploidy had a recurrence, compared to 20 of 391 (5%) with normal DNA ploidy (p < 0.0001). Similarly, in 101 patients with dysplastic cytological findings 39 (39%) with abnormal DNA ploidy had transitional cell carcinoma recurrence compared to 4 of 25 with normal ploidy (p = 0.033).
Abnormal DNA ploidy determined by image analysis significantly enhances the detection of bladder tumor recurrence in patients with atypical or dysplastic cytology but not in those with normal cytology or frank carcinoma on cytological findings.
我们确定通过图像分析细胞术进行的脱氧核糖核酸（DNA）倍体分析是否能增强膀胱复发性移行细胞癌的细胞学诊断。
在5年期间进行了一项回顾性研究，以评估469例先前诊断为浅表性移行细胞癌患者的细胞学诊断和DNA倍体分析。对1034份尿液和膀胱冲洗标本进行了细胞学和DNA倍体分析，并根据临床指征通过膀胱镜检查和活检对患者进行监测。细胞学结果分为正常、非典型、发育异常或癌性，若二倍体指数为1.2或更低、S期+G2M期分数小于21%或超二倍体细胞为3%或更少，则DNA倍体定义为正常；若S期+G2M期分数增加、直方图上出现非整倍体峰或存在四倍体或超二倍体，则定义为异常。
细胞学诊断为癌的大多数患者（88例中的85例，97%）DNA倍体异常，其中85例中的60例（71%）在6个月内被诊断为复发。细胞学正常的284份标本中只有5例（2%）DNA倍体异常，这5例中的1例（20%）预示着移行细胞癌复发。然而，在145例细胞学结果为非典型的患者中，29例（20%）DNA倍体异常者出现复发，而391例（5%）DNA倍体正常者中有20例复发（p<0.0001）。同样，在101例细胞学结果为发育异常的患者中，39例（39%）DNA倍体异常者出现移行细胞癌复发，而25例倍体正常者中有4例复发（p=0.033）。
通过图像分析确定的异常DNA倍体显著增强了细胞学结果为非典型或发育异常患者膀胱肿瘤复发的检测，但对细胞学结果为正常或明显癌性的患者则不然。
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