尿路上皮癌诊断中DNA倍体分析和尿脱落细胞学检查的临床价值  

Diagnostic accuracy of DNA cytometry and urinary cytology in urothelial carcinomas

作　　者：唐燕[1] 余龙[1] 

机构地区：[1]复旦大学遗传工程国家重点实验室,上海200433

出　　处：《临床与实验病理学杂志》2015年第6期636-639,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨DNA倍体分析和尿脱落细胞学检查对尿路上皮癌诊断的临床价值,寻找早期诊断尿路上皮癌的理想方法。方法随机收集121例尿路上皮癌患者的尿液标本作为实验组,另取95例良性血尿非肿瘤患者的尿液标本作为对照组,分别进行尿脱落细胞学检查和DNA倍体分析。结果尿脱落细胞学检查的敏感性高于DNA倍体分析,但特异性低于DNA倍体分析。尿脱落细胞学检查敏感性为85.10%,特异性为76.80%;DNA倍体分析敏感性为81.80%,特异性为81.10%。121例中,膀胱癌103例,上尿路上皮癌18例。对于不同分型的尿路上皮癌,两种方法在高级别肿瘤中均有较好的敏感性,尤其是DNA倍体分析在浸润性膀胱癌和上尿路上皮癌的诊断中具有极好的敏感性,均>94%。结论 DNA倍体分析结合尿脱落细胞学检查,可大大提高尿路上皮癌检测的特异性,以及增加对浸润性膀胱癌及上尿路上皮癌诊断的灵敏度,是对尿路上皮癌检测方法的有利补充。Purpose To assess the potential of DNA image cytometry and urinary cytology in screening for urothelial carcinomas,and to find the ideal method of early diagnosis of urothelial cancer. Methods Voided urine specimens from 121 patients with urothelial carcinoma were randomly collected as test group and 95 patients with symptomatic urologic disease but not urothelial carcinoma as con-trol group,all of the specimens were analyzed by both urinary cytology and DNA image cytometry. Results Urinary cytology had a higher sensitivity but lower specificity in diagnosis of urothelial carcinoma than that of DNA cytometry. Urinary cytology yielded an o-verall sensitivity of 85. l0%,specificity of 76. 80%. DNA cytometry revealed a sensitivity of 81. 80%,specificity of 81. 10%. Among the 121 urothelial carcinoma,there were 103 bladder cancers,18 patients with upper urothelial carcinoma. For different types of urothelial carcinoma,both of the two methods demonstrated good sensitivity in the high level tumor. And DNA cytometry had excellent sensitivity in the diagnosis of urothelial carcinoma in invasive bladder cancer and upper urinary tract cancer,and both were more than 94%. Conclusions In light of its highly good sensitivity and specificity in urothelial carcinoma,especially in invasive bladder cancer and upper urinary tract cancer,DNA cytometry should be used to evaluate suspect urothelial cells in urinary cytology specimens. Com-bined with the conventional urinary cytology,the detection for urothelial carcinoma would be significantly improved.

关 键 词：膀胱肿瘤 尿路上皮癌 DNA倍体 尿脱落细胞学检查 诊断 

分 类 号：R737.14[医药卫生—肿瘤]