尿脱落细胞荧光原位杂交检查阳性在尿路上皮癌中的临床价值

发布时间：2018-11-19 14:50

【摘要】：目的:分析尿脱落细胞荧光原位杂交(fluorescence in situ hybridization,FISH)检查阳性的临床病理特点,评估FISH诊断尿路上皮癌(urothelial carcinoma,UC)的临床应用价值。方法:对北京大学第一医院泌尿外科2012年4月至2015年9月收治的271例FISH检查阳性患者的临床资料进行回顾性研究分析。通过与尿脱落细胞学、膀胱镜和输尿管镜检查相比较,总结分析FISH阳性病例的临床病理特点,采用卡方检验对肿瘤的分期和分级进行比较。结果:在FISH检查阳性的病例中,FISH诊断尿路上皮癌的阳性预测值(positive predict value,PPV)为76.4%,其95%可信区间(confidence interval,CI)为71.3%~81.5%,与尿脱落细胞学检查结果(PPV 86.8%,95%CI:78.5%~95.0%)相近,而低于膀胱镜及输尿管镜检查结果(PPV 96.1%,95%CI:91.7%~100.0%)。FISH的PPV显著高于国外报道(53.9%),差异有统计学意义(χ2=33.048,P0.001)。尿脱落细胞学检查阳性组和阴性组在尿路上皮癌的肿瘤大小、病理分期和分级方面差异没有统计学意义。FISH检测阳性的输尿管癌中,高级别尿路上皮癌占92.3%,与国内的相关报道相比差异有统计学意义。结论:FISH的PPV相对较高,有助于尿路上皮癌的诊断,FISH检查阳性的输尿管癌临床病理分级更高,可考虑行根治性手术并加强术后的随访监测。
[Abstract]:Objective: to analyze the clinicopathological features of urinary exfoliative cell fluorescence in situ hybridization (fluorescence in situ hybridization,FISH) and to evaluate the clinical value of FISH in the diagnosis of urinary epithelial carcinoma (urothelial carcinoma,UC). Methods: the clinical data of 271 FISH positive patients in Urology Department of the first Hospital of Peking University from April 2012 to September 2015 were analyzed retrospectively. By comparing with urine exfoliative cytology, cystoscopy and ureteroscopy, the clinicopathological features of FISH positive cases were summarized and compared with the staging and grading of tumors by chi-square test. Results: the positive predictive value (positive predict value,PPV) of FISH in the diagnosis of urothelial carcinoma was 76.4 and its 95% confidence interval (confidence interval,CI) was 71.3% and 81.5% respectively. The results of urine exfoliative cytology (PPV 86.8%) were lower than those of cystoscopy and ureteroscopy (PPV 96.1%). The PPV of 95 CI: 91.7%). FISH was significantly higher than that of foreign reports (53.9%), and the difference was statistically significant (蠂 2 + 33.048% P0.001). There was no significant difference in tumor size, pathological stage and grade between positive and negative urine exfoliative cytology. High grade urothelial carcinoma accounted for 92.3% of ureteral carcinoma positive for FISH. Compared with the related reports in China, the difference is statistically significant. Conclusion: the PPV of FISH is relatively high, which is helpful for the diagnosis of urothelial carcinoma and the higher clinicopathologic grade of ureteral carcinoma with positive FISH examination.
【作者单位】：北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男性生殖系肿瘤研究中心;
【分类号】：R737.1

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