DNA含量检测在尿脱落细胞病理学漏诊可疑膀胱癌患者中的临床价值

The clinical value of DNA content detection in suspected bladder cancer patients with pathological missed diagnosis of urine exfoliated cells

目的探讨DNA含量检测在可疑膀胱癌但尿脱落细胞病理学检查(简称尿检)阴性或不确定患者中的应用价值。方法挑选临床初诊怀疑膀胱癌但尿检(HE染色)阴性或不确定的患者56例,采用Feulgen染色检测尿脱落细胞DNA含量,以手术切除标本组织病理学诊断结果作为“金标准”进行比对分析。结果56例患者中,尿检阴性35例,不确定21例;DNA含量检测阴性31例,阳性患者25例;组织病理学诊断阴性23例,阳性33例。DNA含量检测的灵敏度为51.52%(17/33),特异度为65.22%(15/23)。尿检准确度为33.93%(19/56),DNA含量检测准确度为57.14%(32/56),两者比较差异有统计学意义(P<0.01)。DNA含量检测在尿检阴性患者中的灵敏度和特异度分别为25.00%(4/16)、73.68%(14/19);在不确定患者中的灵敏度和特异度分别为76.47%(13/17)、25.00%(1/4)。DNA含量检测的检出率在漏诊的高级别膀胱癌患者中为75.00%(6/8),在低级别膀胱患者中为44.00%(11/25),在阴性患者中为34.78%(8/23)。结论尿脱落细胞DNA含量检测在尿检阴性和不确定患者中的灵敏度和特异度均较高,可有效降低尿检漏检率。

Objective To investigate the application value of DNA content detection in patients with suspected bladder cancer but negative or uncertain urine cytology.Methods A total of 56 patients with suspected bladder cancer but negative or uncertain urine cytology(HE staining)were selected.was detected by Feulgen staining,and the results were analyzed.The pathological diagnosis of surgical specimen was used as the standard for comparative analysis.Results Among the 56 patients diagnosed by urine cytology,35 cases were negative and 21 cases were uncertain.DNA content was negative in 31 cases and positive in 25 cases.Among the patients with negative pathological results of urine cytology,23 patients had negative histopathological diagnosis and 33 patients had positive histopathological diagnosis.Among the LBP negative cases,the histological diagnosis was negative in 23 and positive in 33.In the 56 cases with negative or uncertain results of urine cytology,the sensitivity of DNA content detection was 51.52%(17/33)and the specificity was 65.22%(15/23).The accuracy of urine cytology detection was 33.93%(19/56),and the accuracy of DNA content detection was 57.14%(32/56),and the difference was statistically significant(P<0.01).The sensitivity and specificity of DNA content detection in urine negative patients were 25.00%(4/16)and 73.68%(14/19),respectively;The sensitivity and specificity in uncertain patients were 76.47%(13/17)and 25.00%(1/4),respectively.The detection rate of DNA content detection was 75.00%(6/8)in high-grade bladder cancer patients who missed diagnosis,44.00%(11/25)in low-grade bladder patients,and 34.78%(8/23)in negative patients.Conclusion The sensitivity and specificity of DNA content detection in urine exfoliated cells are high in patients with negative and uncertain urine cytology,which can effectively reduce the missed detection rate of urine exfoliated cells.