荧光原位杂交技术、尿脱落细胞学与膀胱镜在膀胱尿路上皮癌诊断及术后复发监测中的应用与对比研究

发布时间：2018-02-07 15:36

  本文关键词： 膀胱尿路上皮癌 荧光原位杂交技术 尿脱落细胞学 膀胱镜 诊断 复发　出处：《华中科技大学》2016年博士论文　论文类型：学位论文

【摘要】：目的比较荧光原位杂交技术(FISH)检查、尿脱落细胞学检查和膀胱镜检查对于膀胱尿路上皮癌患者的诊断价值,以及三种检查对于监测膀胱尿路上皮癌患者术后复发的诊断价值,为完善膀胱尿路上皮癌患者的诊断策略提供理论基础。方法第一部分：因血尿或其他相关临床症状就诊的2478例可疑膀胱尿路上皮癌患者,完善荧光原位杂交技术(FISH)检查、尿脱落细胞学检查和膀胱镜检查,并以术后病理检查诊断结果为“金标准”,分别比较三种检查诊断膀胱尿路上皮癌总的敏感性和特异性,以及对于不同膀胱肿瘤分期的患者,比较三种检查在不同膀胱肿瘤分期中诊断的敏感性差异。第二部分：82例确诊为膀胱尿路上皮癌的患者,行经尿道膀胱肿瘤切除术(TURBT),分别在术后3个月、6个月、9个月和12个月于我院复诊,每次复诊时完善荧光原位杂交技术(FISH)检查、尿脱落细胞学检查和膀胱镜检查,分别比较三种检查在每个复诊时间点的阳性结果检出率,以及三种检查阳性结果平均检出时间的差异,和FISH技术检查结果阳性对于判断膀胱尿路上皮癌患者复发的价值。结果第一部分：在2478名可疑膀胱尿路上皮癌的患者中,荧光原位杂交技术(FISH)检查、尿脱落细胞学检查和膀胱镜检查总的敏感性分别为80.81%、26.65%、88.27%,分别比较三种检查总的敏感性,均存在显著差异,具有统计学意义。FISH技术检查、尿脱落细胞学检查和膀胱镜检查总的特异性分别为90.20%、95.71%、85.66%,分别比较三种检查总的特异性,均存在显著差异,具有统计学意义。荧光原位杂交技术(FISH)检查在膀胱尿路上皮癌患者的不同肿瘤分期中,诊断的敏感性分别为Ta期66.96%、T1期78.69%、T2期84.99%、T3/4期98.92%,尿脱落细胞学检查在不同肿瘤分期中诊断的敏感性分别为Ta期6.09%、T1期16.98%、T2期40.46%、T3/4 67.57%,膀胱镜检查在不同肿瘤分期中诊断的敏感性分别为Ta期71.30%、T1期85.25%、T2期99.24%、T3/4期100.00%。Ta期膀胱尿路上皮癌患者的诊断,FISH技术检查与膀胱镜检查不存在显著差异,其余两组比较存在显著差异。T1期、T2期膀胱尿路上皮癌患者的诊断,三种检查的敏感性均存在显著差异,膀胱镜检查的敏感性最高。T3/4期膀胱尿路上皮癌患者的诊断结果比较与Ta期相同,FISH技术检查与膀胱镜检查不存在显著差异,其余两组比较存在显著差异。第二部分：在82名确诊为膀胱尿路上皮癌的术后患者中,荧光原位杂交技术(FISH)检查在四个复诊时间点的阳性结果检出率分别为术后3个月0%、术后6个月2.44%、术后9个月6.10%、术后12个月4.88%,尿脱落细胞学检查在四个复诊时间点的阳性结果检出率分别为术后3个月0%、术后6个月0%、术后9个月1.22%、术后12个月2.44%,膀胱镜检查在四个复诊时间点的阳性结果检出率分别为术后3个月0%、术后6个月0%、术后9个月2.44%、术后12个月2.44%。FISH技术检查、尿脱落细胞学检查和膀胱镜检查的阳性结果平均检出时间分别为(9.55±2.25)个月、(11.00±1.73)个月、(10.50±1.73)个月。FISH技术检查与另外两种检查方式的阳性结果平均检出时间比较存在差异,比尿脱落细胞学检查和膀胱镜检查的平均检出时间更短。在术后一年的随访过程中,共有4名患者确定复发,肿瘤分期与首次手术时相比没有进展,其中2例是膀胱癌分期为T2期的患者,占11例T2期术后患者的18.18%,均于术后9个月复发,另外2例是膀胱癌分期为T1期的患者,占56例T1期术后患者的3.57%,术后12个月复发,Ta期膀胱癌患者未见复发。4名确定膀胱癌复发的患者,FISH技术检查结果均为阳性。结论目前,膀胱镜检查依然是膀胱尿路上皮癌的术前诊断和术后复发监测的“金标准”。荧光原位杂交技术(FISH)检查对于膀胱尿路上皮癌患者的诊断具有很高的敏感性和特异性,尤其可以作为早期筛查膀胱尿路上皮癌一种检查方式。无论是膀胱尿路上皮癌的诊断,还是术后复发监测,当FISH技术检查阳性而膀胱镜检查阴性时,需要更加密切的进行随访,警惕膀胱肿瘤的发生。尿脱落细胞学检查对于膀胱尿路上皮癌患者的诊断敏感性较低,仅作为其他检查的辅助检查。
[Abstract]:Comparison of fluorescence in situ hybridization (FISH) objective examination, urine cytology and cystoscopy for the diagnosis of bladder urothelial carcinoma patients, and three kinds of check value for diagnosis of recurrence patients monitoring of bladder urothelial carcinoma, and provide a theoretical basis for improvement of diagnostic strategies of bladder urothelial carcinoma patients. Methods: in the first part, from 2478 cases of suspected bladder urothelial cancer hematuria or other related clinical symptoms, improve the fluorescence in situ hybridization (FISH) examination, urine cytology and cystoscopy, and postoperative pathological diagnosis results as gold standard, to compare the three diagnostic sensitivity and the specificity of urothelial carcinoma of the bladder and the bladder tumor staging for different patients, comparison of three kinds of examination in the early diagnosis of bladder cancer in different stages of sensitivity difference. Second Part: 82 cases of bladder urothelial carcinoma patients underwent transurethral resection of bladder tumor (TURBT), 3 months respectively after operation, 6 months, 9 months and 12 months in our hospital visit, at every visit to improve the fluorescence in situ hybridization (FISH) examination, urine cell examination and cystoscopy, compare the three check positive results in the time of each visit the detection rate, and three positive results check the average detection time difference value of positive and FISH examination results for diagnosis of bladder urothelial cancer recurrence. Results: in the first part of the 2478 suspected bladder urothelial carcinoma patients, fluorescence in situ hybridization (FISH) examination, urine cytology and cystoscopy total sensitivity were 80.81%, 26.65%, 88.27%, respectively. The sensitivity comparison of three check the total, there are significant differences statistically Significance of.FISH examination, urine cytology and cystoscopy total specificity were 90.20%, 95.71%, 85.66% respectively, the specificity three examination, there were significant differences, with statistical significance. The fluorescence in situ hybridization (FISH) were examined in different tumor bladder urothelial cancer staging in the sensitivity of diagnosis were Ta stage 66.96%, T1 stage 78.69%, T2 stage 84.99%, T3/4 stage 98.92%, urine cytology in the staging of different sensitivity of tumor diagnosis were Ta 6.09%, T1 16.98%, T2 40.46%, T3/4 67.57%, cystoscopy in the staging of different sensitivity of tumor diagnosis respectively. Ta stage 71.30%, T1 stage 85.25%, T2 stage 99.24%, T3/4 stage 100.00%.Ta diagnosis of bladder urothelial carcinoma patients, FISH examination and cystoscopy and there is no significant difference between the other two groups were compared, there was significant difference in.T1, T2 The diagnosis of bladder urothelial carcinoma patients, sensitivity of three kinds of examination were significantly different, the highest.T3/4 sensitivity in the diagnosis of urothelial carcinoma were cystoscopy results compared with Ta at the same time, FISH examination and cystoscopy there is no significant difference between the other two groups there were significant differences in second. Part: in the 82 patients diagnosed as bladder urothelial carcinoma after operation, fluorescence in situ hybridization (FISH) examination in the positive results of the four time points were respectively 3 months after surgery, 0%, 6 months after surgery, 2.44%, 9 months after surgery, postoperative 6.10%, 12 4.88% months, urine cytology positive results in the four follow-up time points were detected in 3 months after surgery, 0%, 6 months after surgery, 0%, 9 months after surgery, 1.22%, 12 months after surgery, 2.44%, cystoscopy in the positive results of the four time points of the detected rate of return respectively. For operation 鍚，

本文编号：1494720