膀胱癌检测中筛查方法的比较。

Comparison of screening methods in the detection of bladder cancer.

作者信息

Ramakumar S, Bhuiyan J, Besse J A, Roberts S G, Wollan P C, Blute M L, O'Kane D J

机构信息

Department of Urology, Mayo Graduate School of Medicine, Rochester, Minnesota, USA.

出版信息

J Urol. 1999 Feb;161(2):388-94.

PMID:9915409

Abstract

PURPOSE

We prospectively evaluate and compare the sensitivity and specificity of urine cytology, BTA stat, NMP22, fibrin/fibrinogen degradation products (FDP), telomerase, chemiluminescent hemoglobin and hemoglobin dipstick to detect bladder cancer.

MATERIALS AND METHODS

Single voided specimens were obtained from 57 patients with bladder cancer, and 139 without evidence of bladder malignancy on cystoscopy or a negative biopsy of indeterminate lesions. A cytology report was available for 125 patients and interpreted independently. BTA stat, NMP22 and FDP were analyzed according to manufacturer specifications. The telomerase assay was performed on cells collected from urine by centrifugation in preparation for polymerase chain reaction based amplification using the telomeric repeat amplification protocol assay. The chemiluminescent screening assay for hemoglobin in urine uses the pseudoperoxidase activity of hemoglobin on hydrogen peroxide and subsequent oxidation of 7-dimethylaminonaphthalene-1,2-dicarbonic acid hydrazide to generate chemiluminescence emission. Hemoglobin dipstick was interpreted as positive if the hemoglobin content in the urine was trace or greater.

RESULTS

Overall sensitivity with urine cytology, BTA stat, NMP22, FDP, telomerase, chemiluminescent hemoglobin and the hemoglobin dipstick was 44, 74, 53, 52, 70, 67 and 47%, respectively. Specificity with cytology, telomerase and FDP was high (95, 99 and 91%, respectively) but BTA stat, NMP22 (optimized), chemiluminescent hemoglobin (optimized) and the hemoglobin dipstick demonstrated lower specificity of 73, 60, 63 and 84%, respectively. Stepwise logistic regression analysis revealed that for all tumors, and within each tumor grade and stage telomerase had the strongest association with bladder cancer among all tests (69% overall concordance). Telomerase was also positive in 91% of the patients (10 of 11) with carcinoma in situ.

CONCLUSIONS

Urinary telomerase had the highest combination of sensitivity and specificity (70 and 99%, respectively) for bladder cancer screening in these patients. It was the strongest predictor with superior accuracy in patients with grade 1 and noninvasive tumors (pTa), and extremely useful in patients with carcinoma in situ. Telomerase appears to be promising and outperformed cytology, BTA stat, NMP22, FDP, chemiluminescent hemoglobin and hemoglobin dipstick in the prediction of bladder cancer.

摘要

目的

我们前瞻性地评估并比较尿细胞学检查、BTA stat、NMP22、纤维蛋白/纤维蛋白原降解产物（FDP）、端粒酶、化学发光血红蛋白和血红蛋白试纸条检测膀胱癌的敏感性和特异性。

材料与方法

从57例膀胱癌患者以及139例膀胱镜检查未发现膀胱恶性病变或不确定病变活检为阴性的患者中获取单次晨尿标本。125例患者有细胞学检查报告且由独立人员解读。BTA stat、NMP22和FDP按照制造商说明书进行分析。端粒酶检测是对通过离心从尿液中收集的细胞进行，以使用端粒重复序列扩增协议检测法基于聚合酶链反应进行扩增。尿液中血红蛋白的化学发光筛查检测利用血红蛋白对过氧化氢的拟过氧化物酶活性以及随后7 - 二甲基氨基萘 - 1,2 - 二羧酸酰肼的氧化以产生化学发光发射。如果尿液中血红蛋白含量为微量或更高，则血红蛋白试纸条判为阳性。

结果

尿细胞学检查、BTA stat、NMP22、FDP、端粒酶、化学发光血红蛋白和血红蛋白试纸条的总体敏感性分别为44%、74%、53%、52%、70%、67%和47%。细胞学检查、端粒酶和FDP的特异性较高（分别为95%、99%和91%），但BTA stat、NMP22（优化后）、化学发光血红蛋白（优化后）和血红蛋白试纸条的特异性较低，分别为73%、60%、63%和84%。逐步逻辑回归分析显示，对于所有肿瘤以及每个肿瘤分级和分期，在所有检测中，端粒酶与膀胱癌的关联最强（总体一致性为69%）。在11例原位癌患者中，有10例（91%）端粒酶也呈阳性。

结论

在这些患者中，尿端粒酶在膀胱癌筛查中具有最高的敏感性和特异性组合（分别为70%和99%）。它是1级和非侵袭性肿瘤（pTa）患者中最强的预测指标，准确性更高，对原位癌患者极为有用。在预测膀胱癌方面，端粒酶似乎很有前景，优于细胞学检查、BTA stat、NMP22、FDP、化学发光血红蛋白和血红蛋白试纸条。