Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma
Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma
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DOI：
10.1111/j.1464-410x.2010.09899.x
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发表时间：
2011-09-01
影响因子：
4.5
通讯作者：
Raman, Jay D.
中科院分区：
文献类型：
--
作者：
Messer, Jamie;Shariat, Shahrokh F.;Raman, Jay D.
目的评价尿细胞学对上尿路上皮癌（UTUC）患者行切除手术的侵袭性疾病诊断的准确性。方法：我们回顾了326例行根治性肾输尿管切除术或远端输尿管切除术的患者的泌尿细胞学资料，这些患者没有并发或既往的膀胱癌。我们评估了细胞学（阳性、阴性和非典型）与最终病理的关系。计算高级别和肌肉侵袭性UTUC的阳性（+/-非典型）细胞学的敏感性和阳性预测值（PPV）。结果在最终病理中，53%的患者为非肌肉侵袭性疾病（pTa、pTis、pT1）， 47%的患者为侵袭性疾病（>= pT2）。低级别和高级别癌症分别出现在33%和67%的患者中。尿细胞学阳性、不典型和阴性分别占40%、40%和20%。尿细胞学阳性的敏感性和PPV对高级别和肌肉侵袭性UTUC分别为56%和54%和62%和44%。细胞学阳性的非典型细胞学纳入提高了高度（74%和63%）和肌肉侵袭性（77%和45%）UTUC的敏感性和PPV。与膀胱标本相比，选择性输尿管细胞学检查患者的限制性分析进一步提高了诊断准确性（PPV对高级别和肌肉侵袭性UTUC的诊断准确率为85%）。结论：在接受根治性手术治疗的UTUC患者队列中，单独的尿细胞学检查缺乏准确预测肌肉侵袭性或高度病变的表现特征。改进病理分级和分期的替代标记是必要的，特别是在考虑内镜下治疗UTUC时。
OBJECTIVETo evaluate the diagnostic accuracy of urine cytology for detecting aggressive disease in a multi-institutional cohort of patients undergoing extirpative surgery for upper-tract urothelial carcinoma (UTUC).METHODSWe reviewed the records of 326 patients with urinary cytology data who underwent a radical nephroureterectomy or distal ureterectomy without concurrent or previous bladder cancer.We assessed the association of cytology (positive, negative and atypical) with final pathology. Sensitivity and positive predictive value (PPV) of a positive (+/- atypical) cytology for high-grade and muscle-invasive UTUC was calculated.RESULTSOn final pathology, 53% of patients had non-muscle invasive disease (pTa, pTis, pT1) and 47% had invasive disease (>= pT2). Low-grade and high-grade cancers were present in 33% and 67% of patients, respectively.Positive, atypical and negative urine cytology was noted in 40%, 40% and 20% of cases. Positive urinary cytology had sensitivity and PPV of 56% and 54% for high-grade and 62% and 44% for muscle-invasive UTUC.Inclusion of atypical cytology with positive cytology improved the sensitivity and PPV for high-grade (74% and 63%) and muscle-invasive (77% and 45%) UTUC. Restricting analysis to patients with selective ureteral cytologies further improved the diagnostic accuracy when compared with bladder specimens (PPV > 85% for high-grade and muscle-invasive UTUC).CONCLUSIONSIn this cohort of patients with UTUC treated with radical surgery, urine cytology in isolation lacked performance characteristics to accurately predict muscle-invasive or high-grade disease.Improved surrogate markers for pathological grade and stage are necessary, particularly when considering endoscopic modalities for UTUC.