尿脱落细胞嗜银染色结合B超联合诊断膀胱癌经尿道手术后复发

Urine Cytology Silver Stain Combined with Ultrasonography in the Detection of Recurrence of Bladder Cancer

目的评价尿脱落细胞嗜银染色结合B超联合诊断膀胱移行细胞癌经尿道手术后复发的敏感性和特异性。方法采用盲法对每一纳入研究对象同时进行尿脱落细胞嗜银染色、经直肠B超和膀胱镜检查,以膀胱镜结合病理检查的结果为金标准,计算尿脱落细胞嗜银染色结合B超联合诊断膀胱癌经尿道手术后复发的敏感性、特异性和ROC曲线下面积。当尿脱落细胞嗜银染色或/和B超阳性时,联合诊断试验的结果为阳性;当尿脱落细胞嗜银染色和B超均阴性时,联合诊断试验的结果为阴性。结果纳入148例膀胱移行细胞癌经尿道手术后1年以上的门诊随访病例,其中57例复发,复发率为38·51%。单用尿脱落细胞嗜银染色诊断复发的敏感性和特异性是89·47%[95%CI(0·82,0·98)]和87·91%[95%CI(0·81,0·95)],ROC曲线下面积为82·22%。单用B超诊断复发的敏感性和特异性是57·90%[95%CI(0·45,0·71)]和90·11%[95%CI(0·84,0·96)],ROC曲线下面积73·13%。当结合尿脱落细胞嗜银染色和B超联合诊断时,敏感性提高至94·74%[95%CI(0·89,1·00)],而特异性有所下降,为84·62%[95%CI(0·77,0·92)],ROC曲线下面积增加为98·28%。结论非侵入性的尿脱落细胞嗜银染色结合B超联合诊断膀胱移行细胞癌经尿道手术后复发的价值较高,可常规用于术后病例的随访。

Objective To evaluate the urine cytology silver staining combined with ultrasonography（USG） in the detection of bladder transitional cell carcinoma （TCC） recurrence after transurethral resection of bladder tumor（TURBT） in terms of sensitivity and specificity. Methods Cystoscopy was used as “gold standard”. Urine cytology combined with USG or cystoscopy was measured separately and blindly. AgNORs protein stained by silver were used in cytology with Kappa of inter-observers 0.81. For the USG, the patients were scanned with trans-rectal probe with Kappa of inter-observers 0.76. The results of urine cytology combined with USG （ Positive when urine cytology and/or USG positive. Negative when both urine cytology and USG negative） were compared with “gold standard”. Results The 148 consecutive superficial TCC patients with TURBT one year previously were included in this study. Fifty seven recurrenced cases were detected. Recurrence rate was 38.51%. The sensitivity and specificity of urine cytology silver stain were 89.47% （95% CI 0.82 to 0.98） and 87.91% （95% CI 0.81 to 0.95）. Area under ROC curve was 82.22%. The sensitivity and specificity of USG were 57.90% （95% CI 0.45 to 0.71 ） and 90. 11% （ 95% CI 0.84 to 0.96）. Area under ROC curve was 73.13% . The sensitivity was improved to 94. 74% （95% CI 0.89 to 1.00） when cytology combined with USG. But specificity decreased to 84. 62% （95% CI 0.77 to 0.92 ）. Area under ROC curve was improved to 98.28%. Conclusions Urine cytology silver stain combined with USG improves the high sensitivity for follow-up TCC patients after TURBT. The non-invasive protocol is suggested.