Pode D, Golijanin D, Sherman Y, Lebensart P, Shapiro A
Department of Urology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
J Urol. 1998 Feb;159(2):389-92; discussion 393. doi: 10.1016/s0022-5347(01)63928-4.
We examined the use of immunostaining of the Lewis X antigen in exfoliated cells from voided urine samples, cytopathology and bladder ultrasound for noninvasive detection of bladder tumors as a potential substitute for cystoscopy.
A total of 260 patients were included, of whom 80 were evaluated because of irritative symptoms or hematuria and 180 were examined during followup visits after resection of bladder tumors. Voided urine samples were obtained from each patient for immunocytology and cytopathology. Bladder ultrasound and cystoscopy were performed. Biopsies were obtained whenever a bladder tumor was seen or if carcinoma in situ was suspected. Indirect immunoperoxidase staining was done on cytocentrifuge slides, using the P12 monoclonal antibody against the Lewis X antigen.
Cystoscopy and biopsies revealed bladder tumors in 84 patients. Immunocytology of 1 urine sample resulted in a sensitivity of 79.8% and a specificity of 86.4%. The diagnosis of primary carcinoma in situ by immunocytology was correct in 100% of the cases. The examination of 2 consecutive urine samples detected 95.1% of the tumors. False-negative results occurred in a few cases with small, superficial, low grade tumors. Cytopathology and bladder ultrasound resulted in a sensitivity of 47.6 and 66.7%, and a specificity of 97.7 and 97.2%, respectively. The results of immunocytology of 2 urine samples were equivalent to the combination of immunocytology of a single urine sample, cytology and ultrasound.
Immunostaining of the Lewis X antigen is significantly more sensitive than cytopathology for the detection of low grade as well as high grade tumor cells in voided urine. Immunocytological evaluation of 2 consecutive voided urine specimens for the Lewis X antigen is the most sensitive method currently available for noninvasive detection of transitional cell tumors. This assay may replace cystoscopy for detection of bladder cancer.
我们研究了利用对来自排尿样本的脱落细胞进行Lewis X抗原免疫染色、细胞病理学检查及膀胱超声检查，以无创检测膀胱肿瘤，作为膀胱镜检查的潜在替代方法。
共纳入260例患者，其中80例因刺激性症状或血尿接受评估，180例在膀胱肿瘤切除术后的随访期间接受检查。从每位患者获取排尿样本用于免疫细胞学和细胞病理学检查。进行膀胱超声和膀胱镜检查。一旦发现膀胱肿瘤或怀疑原位癌，即进行活检。使用抗Lewis X抗原的P12单克隆抗体在细胞离心涂片上进行间接免疫过氧化物酶染色。
膀胱镜检查和活检发现84例患者存在膀胱肿瘤。1份尿液样本的免疫细胞学检查敏感性为79.8%，特异性为86.4%。免疫细胞学对原发性原位癌的诊断在所有病例中均正确。连续检查2份尿液样本可检测出95.1%的肿瘤。少数小的、表浅的、低级别肿瘤出现假阴性结果。细胞病理学和膀胱超声检查的敏感性分别为47.6%和66.7%，特异性分别为97.7%和97.2%。2份尿液样本的免疫细胞学检查结果等同于1份尿液样本的免疫细胞学检查、细胞学检查和超声检查的联合结果。
对于检测排尿中的低级别和高级别肿瘤细胞，Lewis X抗原免疫染色比细胞病理学检查显著更敏感。对连续2份排尿标本进行Lewis X抗原的免疫细胞学评估是目前可用于无创检测移行细胞肿瘤的最敏感方法。该检测方法可替代膀胱镜检查用于膀胱癌的检测。
