PSA值增高患者前列腺按摩后尿液细胞学检查的临床意义

Clinical significance of cytology in urine after prostate massage of patients with high PSA value

目的研究接受前列腺按摩术后的血清PSA增高者的尿液细胞学检查,评估其用于鉴别诊断前列腺癌的价值。方法 126例PSA值增高的患者在行经直肠前列腺穿刺活检前或术前获取前列腺液,进行瑞氏染色和脱落细胞学分级。结果病理学结果 87例(69.05%)为前列腺癌,39例(30.65%)为非前列腺癌组织。脱落细胞学检查结果一至五级分别有8例(9.19%)、13例(17.94%)、21例(24.14%)、26例(29.89%)、19例(21.84%)。脱落细胞学检查具有100%的特异性,在PSA≥20μg/L的患者中,具有较高的敏感性(57.89%)。在脱落细胞学分级一至四级之间PSA值差异无统计学意义,一至四级与五级之间PSA值比较差异有统计学意义。结论 PSA值增高患者中行前列腺液脱落细胞学检查诊断前列腺癌是一种有效的方法,尤其是在患者具有较高的PSA值的时候,具有无侵入性,具有较高的敏感性和特异性,较前列腺活检的损伤更小。

Objective lb study clinical utility of the exfoliative cytology of urine after prostate massage obtained from the patients with high PSA value. Methods Urine after prostate massage was obtained from 126 patients with high PSA value before prostate biopsy or operation and Wright ＇ s stain and cytologic class was done. Each cytology class and patients＇ age, PSA, were compared. The relationship of patients＇ age, PSA and cytology class was done by the means of spearman correlation analysis. Re- suits Prostate tissue pathology show that 87 （69.05%） cancer and 39 （ 30. 65% ） non-cancer. Patient numbers in cytologic class 1 to 5 were 8 （9. 19% ） ,13 （ 17.94% ） ,21 （24. 14% ） ,26 （29.89%） ,19 （21.84%） respectively. The prostate fluid cy- tology had a specificity of 100% and high sensibility（ 11/19,57. 89% in patient with PSAμ20μg/L）. PSA value has significant difference between classl ,2, 3, 4 and 5. Conclusion The exfoliative cytology of prostatic fluid was a valuable method in detec- ting the prostate cancer especially in patient with a high PSA value, and it has advantages such as non-invasion and less injury than prostate biopsy.