膀胱癌早期诊断方法的进展及评价

膀胱肿瘤是泌尿生殖系最常见的肿瘤 ,90 %以上为移行细胞癌 ,其中 80 %以上为无浸润的浅表性癌 ,初次治疗后复发率高达 70 %。要进一步降低膀胱癌的死亡率 ,需要更好的普查方法及诊断技术 ,这是提高膀胱癌治愈率的关键措施。当前临床上广泛应用的三大标准诊断方法为有创性膀胱镜检查、活组织检查及尿细胞学检查 ,这些检查方法各有优缺点。理想的检测方法应具有高敏感性、高特异性、简便快速、费用低、易标准化、可重复、可预测复发、能在医生办公室进行、对治疗变化敏感等特点。因此 ,许多学者在宏观、微观乃至细胞基因学水平上不懈地探索 ,…     

NMP 22在膀胱癌早期诊断中的临床研究

目的评价尿液NMP 22含量测定在膀胱癌早期诊断中的应用价值,寻找早期诊断膀胱癌的理想方法.方法采用化学发光法测定30例健康人尿中NMP 22水平,以结果的95%可信区间作为正常对照值(1.9～14.7)U/ml,NMP 22＞10 U/ml为阳性界值.对镜下血尿者51例,有膀胱癌手术史者9例,肉眼血尿者8例的尿液NMP 22值进行测定.男52例,(60±10)岁,女16例,(41±12)岁.68例NMP 22检测后均进行尿细胞学检查和膀胱镜检查,可疑处取材活检18例.统计学比较尿NMP 22和尿细胞学检测结果.结果68例患者中NMP 22阳性22例,其中经活检证实为膀胱癌11例(含术后复发者1例).NMP 22检测灵敏度为100%(11/11),特异度为81%(46/57).尿细胞学检查灵敏度为35%(4/11),特异度为93%(54/57).NMP 22诊断灵敏度高于尿细胞学检查(P＜0.01).11例NMP 22假阳性结果患者随访12个月,确诊为膀胱癌1例(随访至11个月).结论尿NMP 22检测为早期诊断膀胱癌提供了新的方法.     

2005年欧洲泌尿外科会议膀胱癌诊断治疗纲要

膀胱癌诊断治疗指南是欧洲泌尿外科学会(EAU)制订的泌尿外科肿瘤诊治指南之一,并经EAU肿瘤外科工作组批准,于2005年在土耳其伊斯坦布尔召开的年会上通过。提出了①浅表性膀胱肿瘤的分期、特点及其治疗和组织学诊断标准及预后因素;②肌肉浸润以及转移性肿瘤的分期、组织分级标准;③局部肿瘤的诊断、分期和治疗标准;④转移性疾病的治疗;⑤根治性膀胱切除术后的尿流改道;⑥治愈性治疗后的随访标准。     

膀胱癌手术中无瘤技术的配合

２５２例膀胱癌手术中采用术前３０ｍｉｎ膀胱内灌注抗癌药；肿瘤切缘注射抗癌药；术后冲洗、浸泡盆腔、手术区域及尿道等无瘤术的配合防治复发．随访２年结果与对照组比较有显著性差异。     

膀胱平滑肌瘤的诊断和治疗

目的 探讨膀胱平滑肌瘤的病因、诊治方法和预后。方法 回顾性分析1984年至2005年收治6例膀胱平滑肌瘤患者资料。患者男1例，女5例，平均年龄36岁。临床表现为排尿障碍4例、血尿1例、膀胱刺激症状1例。病程1～16个月。除1例血尿患者外，其余5例均非首诊。6例B超检查，首次发现病变3例。5例行CT检查，均发现肿块且有不同程度强化。6例膀胱镜检，发现肿瘤2例，提示占位病变3例。肿瘤直径1．5-5．0cm。6例均采用手术治疗。结果 6例患者术后排尿通畅，血尿消失，排尿刺激症状明显缓解。1例术后出现伤口漏尿，经保守治疗治愈，余未发生其他并发症。6例随访9个月～8年，未见肿瘤复发或转移。结论 膀胱平滑肌瘤是一种少见的良性肿瘤，临床症状不典型，排尿障碍和血尿是最常见的表现，诊断主要依靠B超、CT和膀胱镜检查，初诊时误诊率较高。外科手术治疗预后良好。     

尿癌胚抗原RIA对膀胱癌诊断的实用价值

应用ＲＩＡ技术测定了２８例膀胱癌血、尿ＣＥＡ值，并与泌尿系统良性病变组和泌尿系统其它恶性肿瘤组进行了比较，表明尿ＣＥＡ测定对膀胱癌的诊断有一定实用价值。它的诊断灵敏度与特异性较高，分别为７１％与８２％，且尿ＣＥＡ含量与膀胱癌组织恶性程度和病理分期呈正相关。本法具有方法简易、采样方便、灵敏度高等优点，可望成为膀胱癌高危人群筛选的首选试验和膀胱癌实验室诊断的一种有较方法。     

膀胱癌早期诊断方法的进展及评价(续)

(上接本刊第 1 5卷第 2期第 88页 )2 .4　 M344、1 9A2 1 1和 Immuno Cyt TM测定目前膀胱移行细胞癌的单抗肿瘤标志物中 ,M344、1 9A2 1 1被认为最具早期临床诊断价值。M344抗原是可被硫还原的高分子类膀胱粘蛋白抗原 ( mucin antigen of urinary bladder,MAUB )的一个糖基表位     

膀胱肿瘤早期诊断的研究进展

膀胱肿瘤早期诊断方法的研究对提高膀胱肿瘤诊断水平具有极其重要的意义。新的膀胱肿瘤检测和检查方法的出现,显著提高了膀胱肿瘤的检测和诊断水平。相信随着膀胱肿瘤发生机制研究的不断深入,新的膀胱肿瘤相关分子的发现和新的生物学技术的应用,都会对研究膀胱肿瘤新的早期诊断方法提供重要帮助。     

Simultaneous determination of six tumor markers in patients with prostatic carcinoma and bladder tumors

Summary Serum levels of fucosyltransferase (FT), phosphohexoseisomerase (PHI), tissue polypeptide antigen (TPA), Tennessee antigen (TAG), carcinoembryonic antigen (CEA) and prostatic acid phosphate (PAP) were determined in 75 healthy individuals and in 86 patients with prostatic carcinoma and 38 patients with bladder tumors. The discrimination capacities of the different markers were compared by using inverse distribution plots. At a rate of 5% false positive values the sensitivities for bladder tumors were: FT 30%, TPA 24%, CEA 16%, TAG 15%. The sensitivities for prostatic carcinoma were: PAP 63%, PHI 36%, TPA 18%, CEA 14%, TAG 14%.     

ImmunoCyt在膀胱移行细胞癌早期诊断中的应用

目的评价ImmunoCyt检测在膀胱癌早期诊断和随访中的作用. 方法膀胱癌患者86例,其中38例为膀胱肿瘤行经尿道膀胱肿瘤电切术后至少3个月的随访患者,48例有肉眼(镜下)血尿,分别进行标准尿脱落细胞学和ImmunoCyt检测.86例均行膀胱镜检查,对可疑组织进行活检. 结果膀胱镜检和病理证实28例为膀胱移行细胞癌.ImmunoCyt敏感性为82%,与尿脱落细胞学检查(39%)相比差异有显著性意义(P<0.05).两种检查方法相结合的敏感性为89%.ImmunoCyt和细胞学的特异性分别为78%和94%. 结论 ImmunoCyt较细胞学对膀胱肿瘤更敏感,二者联合使用可在保持高特异性的前提下提高诊断的敏感性,早期检测膀胱肿瘤.     

Urine markers for detection and surveillance of non-muscle-invasive bladder cancer

Context

Bladder cancer diagnosis and surveillance includes cystoscopy and cytology. The limitation of urinary cytology is its low sensitivity for low-grade recurrences. As of now, six urine markers are commercially available to complement cystoscopy in the detection of bladder cancer. Several promising tests are under investigation.

Objective

In this nonsystematic review, we summarize the existing data on commercially available and promising investigational urine markers for the detection of bladder cancer.

Evidence acquisition

A PubMed search was carried out. We reviewed the recent literature on urine-based markers for bladder cancer. Articles were considered between 1997 and 2011. Older studies were included selectively if historically relevant.

Evidence synthesis

Although different studies have shown the superiority of urine markers regarding sensitivity for bladder cancer detection as compared with cytology, none of these tests is ideal and can be recommended unrestrictedly.

Conclusions

Urine markers have been studied extensively to help diagnose bladder cancer and thereby decrease the need for cystoscopy. However, no marker is available at present that can sufficiently warrant this. Several urinary markers have higher but still insufficient sensitivity compared with cytology. Urinary cytology or markers cannot safely replace cystoscopy in this setting. To identify an optimal marker that can delay cystoscopy in the diagnosis of bladder cancer, large prospective and standardized studies are needed.     

NMP22与BTA stat检测在膀胱肿瘤诊断中的应用

目的评价NMP22和BTAstat诊断膀胱肿瘤的价值.方法对82例临床怀疑膀胱肿瘤的患者,在膀胱镜检查前将尿样分为3份,分别进行NMP22、BTAstat和脱落细胞学检测,分析比较3种方法的敏感性、特异性和阳性预测价值.结果82例中病理证实膀胱肿瘤32例,其他疾病50例.NMP22诊断膀胱肿瘤敏感性为87.5%,与BTAstat(65.6%)、细胞学(21.9%)比较,差别有显著性意义(P<0.05).3种方法诊断特异性分别为84.0%、64.0%和100.0%.阳性预测值分别为77.8%、53.9%和100.0%.结论NMP22是一种简单、敏感、非侵袭性的早期诊断膀胱肿瘤的肿瘤标记物.     

Urine markers for detection and surveillance of bladder cancer

ObjectivesBladder cancer detection and surveillance includes cystoscopy and cytology. Urinary cytology is limited by its low sensitivity for low-grade tumors. Urine markers have been extensively studied to help improve the diagnosis of bladder cancer with the goal of complementing or even replacing cystoscopy. However, to date, no marker has reached widespread use owing to insufficient evidence for clinical benefit.Material and methodsPubmed/Medline search was conducted to identify original articles, review articles, and editorials regarding urine-based biomarkers for screening, early detection, and surveillance of urothelial carcinoma of the bladder. Searches were limited to the English language, with a time frame of 2000 to 2013. Keywords included urothelial carcinoma, bladder cancer, transitional cell carcinoma, biomarker, marker, urine, diagnosis, recurrence, and progression.ResultsAlthough several urinary markers have shown higher sensitivity compared with cytology, it remains insufficient to replace cystoscopy. Moreover, most markers suffer from lower specificity than cytology. In this review, we aimed to summarize the current knowledge on commercially available and promising investigational urine markers for the detection and surveillance of bladder cancer.ConclusionsWell-designed protocols and prospective, controlled trials are needed to provide the basis to determine whether integration of biomarkers into clinical decision making will be of value for bladder cancer detection and screening in the future.     

多项肿瘤标志物联合检测对肝癌早期诊断的作用

目的 探讨多项肿瘤标志物联合检测在原发性肝癌中的诊断价值及建立判别方程.方法 采用蛋白芯片技术,检测2003年11月至2006年4月大坪医院收治的98例原发性肝癌患者(肝癌组)、67例良性肝病患者(肝病组)、46例健康体检者(对照组)血清中的12项肿瘤标志物,并在肝癌组与肝病组患者之间建立判别方程.采用方差分析和X2检验对检测结果进行分析.结果 肝癌组中87例患者肿瘤标志物呈阳性表达(89%),肝病组中有13例呈阳性表达(19%),对照组中有2例呈阳性表达(4%).3组中的AFP、CEA、铁蛋白、CA19-9和CA125检测结果比较,差异有统计学意义(F=59.530,40.472,31.708,75.897,153.066,P<0.05).联合检测这5项指标,肝癌临床诊断符合率提高为89%,明显高于单项AFP检测的64%(X2=16.362,P<0.05).所建判别方程的判断准确率为90%.结论 多项肿瘤标志物联合检测优于单独AFP检测,可用于对肝癌高危人群的筛查及原发性肝癌的早期诊断.     

BTA在膀胱癌诊断中的应用

为了探求对膀胱肿瘤诊断及术后复发监测的理想手段，从１９９５年９月～１９９６年６月，采用ＢＴＡ试剂检测方法对２０２例血尿患者及７１例膀胱肿瘤术后的患者进行了诊断检测，诊断膀胱癌的敏感度为９６％、特异度为８３％、准确度为８６％，２６例膀胱肿瘤患者中仅６例（２３％）尿脱落细胞阳性，正常对照均为阴性。认为ＢＴＡ试剂是一种快速、有效、无创性诊断膀胱肿瘤的方法。     

肿瘤标志物联合检测对肺癌的诊断价值

目的 探讨血浆肿瘤型M2丙酮酸激酶(TuM2-PK)、神经元特异烯醇化酶(NSE)和细胞角蛋白19(CYFRA21-1)联合测定对肺癌诊断的临床意义.方法 用酶联免疫吸附试验(ELISA)法分别检测90例肺癌患者,90例良性肺部疾病和100名健康人血中的TuM2-PK、NSE和CYFRA21-1的浓度.结果 肺癌组3种指标水平均明显高于良性肺疾病组和健康对照组,差异有统计学意义(P＜0.01);TuM2-PK诊断肺癌的敏感度为68.9%,特异度为91%;TuM2-PK和NSE联合检测肺癌的阳性率最高为81%.结论 TuM2-PK可作为一种新肺癌标志物应用,TuM2-PK和NSE联合检测可以提高对肺癌的阳性诊断.