细胞DNA定量分析在尿脱落细胞学鉴别诊断中的应用

Application of DNA-image cytometry in the differential diagnosis of urine cytology

目的探讨细胞DNA定量分析技术在尿脱落细胞学鉴别诊断中的临床价值,提高临床尿路上皮癌的确诊率。方法选择395例泌尿系统疾病患者,分别采用尿脱落细胞薄层细胞学(TCT)和Feulgen染色的细胞DNA定量分析技术(DNA-ICM)进行检测,并将两种结果进行对比,对其中检查结果异常的患者进行组织学活检。结果细胞DNA-ICM在尿路上皮癌诊断中的检出率、敏感度、特异性分别为48.9%(192/395)、94.6%(192/203)、51.4%(203/395),TCT的阳性率、敏感度、特异性分别为28.1%(110/395)、38.4%(110/285)、72.2%(285/395),DNA-ICM检测的敏感度高于TCT的敏感度,二者比较差异显著(P<0.01)。活检结果显示,DNA-ICM对癌、疑癌、异型细胞患者的诊断符合率分别为97.2%、91.3%、80.1%。结论细胞DNA-ICM在尿路上皮癌的诊断中有很好的应用价值,与TCT联合检测可明显提高尿脱落细胞的临床检出率和准确性,减少漏检的发生。

Objective To investigate the clinical value of DNA-image cytometry（ DNA-ICM） in the diagnosis of urinary cytology and to improve the clinical diagnostic rate of urothelial cell carcinomas. Methods A total of 395 patients with urinary system diseases admitted to our hospital were detected with urine thin-layer cytology test（ TCT） and DNA-ICM,respectively. And we compared the results between the 2 methods above mentioned. Patients with abnormal results needed histological biopsy. Results The positive rates,sensitivity and specificity of DNA-ICM were 48. 9%（ 192/395）,94. 6%（ 192/203） and 51. 4%（ 203/395） in the diagnosis of UCC but those of TCT were 28. 1%（ 110/395）,38. 4%（ 110/285） and 72. 2%（ 285/395）,respectively. The sensitivity of DNA-ICM was significantly higher than that of TCT and the difference was statistically significant（ P 〈0. 01）. The biopsy results showed that the diagnostic accuracy of DNA-ICM was 97. 2%,91. 3% and 80. 1%. Conclusion DNA-ICM,which improves the detective rate of urinary cytology,has great application value in the diagnosis of urothelial cell carcinomas. Combined examination of DNA-ICM and TCT will improve the detectable rate and accuracy of urinary cytology and reduce false negative results.