尿液基细胞学在诊断尿路上皮癌中的临床应用价值  

Clinical value of urine liquid-based cytology test in the diagnosis of urothelial carcinoma

作　　者：赵焕[1] 李旻[1] 郭会芹[1] 曹箭[1] 马建辉[2] 李长岭[2] 潘秦镜[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院病理科,100021 [2]北京协和医学院中国医学科学院肿瘤医院泌尿外科,100021

出　　处：《中华检验医学杂志》2008年第6期662-665,共4页Chinese Journal of Laboratory Medicine

基　　金：TerryFox基金资助课题（A2）

摘　　要：目的评估尿液基细胞学（LBC）对尿路上皮癌（UC）诊断的准确性。方法对2005年1月至2007年7月在本院细胞学室做尿LBC检查的603例患者标本和组织学诊断标本进行对照。以细胞学诊断的可疑癌（SUCA）为切入点，组织学诊断为金标准，计算尿液基细胞学的诊断效能。结果在有组织学随访结果的436例患者中，274例为UC、其他恶性肿瘤61例。尿LBC诊断恶性肿瘤的敏感度、特异度和准确性分别为61．5％、86．5％和67．1％。阳性预测值和阴性预测值分别为94．1％和39．2％。对UC和非尿路上皮恶性肿瘤的诊断敏感度分别为68．6％和29．5％，前者显著高于后者。尿LBC诊断敏感度在UCG1和G1—2、G2和G2-3以及C3病理分级中分别为53．3％、74．5％和90．6％，且随UC组织学分级升高而增高。结论尿LBC对病理组织学高级别UC的诊断敏感度高，有很好的临床应用价值，但对低级别UC的诊断敏感度低，需借助细胞学辅助诊断技术予以提高。Objective To explore the diagnostic accuracy of urine liquid-based cytology （LBC） for diagnosis of urothelial carcinoma （ UC）. Methods A total of 603 cases in our department from January 2005 to July 2007 were subject to urine liquid-based cytology test （LBC） and followed by histological examination. Using the histological appearance as the gold standard, the accuracy of LBC test was evaluated. Results A total of 436 cases with histological diagnoses were selected. There were 274 cases of UC and 61 cases of other malignant tumors of urinary system. The sensitivity, specificity and accuracy of urine LBC test for malignant tumors were 61.5% , 86. 5% and 67. 1% , respectively. The positive predictive value and negative predictive value were 94, 1% and 39, 2%, respectively, The sensitivity of urine LBC test for UC and non-urothelial malignant tumors were 68. 6% and 29, 5% , respectively, The sensitivity for UC was significantly higher than that for non-urothelial malignant tumors. The diagnostic sensitivity of urine LBC test for UC G1, G1-2; G2, G2-3 and G3 was 53,3%, 74.5% and 90.6%, respectively. The diagnostic sensitivity of urine LBC was increased with the increacment of histological grade of UC. Conclusions The sensitivity of urine LBC test for high grade UC is high and has a good clinical value, However, for the diagnosis of low grade UC, the sensitivity of LBC test is low and adjuvant test is needed to improve it.

关 键 词：泌尿系肿瘤 癌 细胞诊断学 

分 类 号：R686[医药卫生—骨科学]