背景:尿液细胞学检查是检测高级别尿路上皮癌(HGUC)必不可少的检查;然而,HGUC细胞和形态相似的良性非典型细胞之间的区别提出了临床挑战.在这项研究中,我们对p53和波形蛋白进行了双重免疫染色,以建立一种准确区分HGUC细胞和良性非典型细胞的诊断方法。
方法:本研究包括41例HGUC,11尿石症,和22在组织病理学或临床上诊断的肾小球疾病。从排泄的尿液样本中制备尿液细胞学标本后,进行p53免疫染色,计算p53阳性强度和p53阳性率。随后,对相同标本进行波形蛋白免疫染色以计算波形蛋白阳性率。
结果:HGUC细胞组的平均p53阳性强度为2.40,平均p53阳性率为73.2%,平均波形蛋白阳性率为5.1%。相比之下,平均p53阳性强度,p53阳性率,波形蛋白阳性率分别为1.63、36.7%,和66.2%,分别,良性非典型细胞组。两组各参数之间存在显著差异。此外,结合这三个参数的结果的两个多元逻辑回归模型显示出比单独评估p53阳性强度更高的灵敏度和特异性,阳性率,和波形蛋白阳性率。
结论:因为用p53和波形蛋白双重免疫染色将HGUC细胞与良性非典型细胞区分开来,可以提高尿细胞学诊断的准确性。
BACKGROUND: Urine cytology is an indispensable test for detecting high-grade urothelial carcinoma (HGUC); however, the distinction between HGUC cells and morphologically similar benign atypical cells poses clinical challenges. In this study, we performed double immunostaining for p53 and
vimentin to establish a diagnostic method to accurately distinguish HGUC cells from benign atypical cells.
METHODS: This study included 41 cases of HGUC, 11 of urolithiasis, and 22 of glomerular disease diagnosed histopathologically or clinically. After preparing urine cytology specimens from voided urine samples, p53 immunostaining was performed, and the p53-positive intensity and p53 positivity rate were calculated. Subsequently,
vimentin immunostaining was performed on the same specimens to calculate the rate of
vimentin positivity.
RESULTS: The HGUC cell group had a mean p53-positive intensity of 2.40, a mean p53 positivity rate of 73.2%, and a mean vimentin positivity rate of 5.1%. In contrast, the mean p53-positive intensity, p53 positivity rate, and
vimentin positivity rate were 1.63, 36.7%, and 66.2%, respectively, in the benign atypical cell group. There were significant differences between the two groups for each parameter. Moreover, two multiple logistic regression models combining the results of these three parameters exhibited higher sensitivity and specificity than solely assessing the p53-positive intensity, positivity rate, and
vimentin positivity rate.
CONCLUSIONS: Since double immunostaining with p53 and
vimentin distinguishes HGUC cells from benign atypical cells, it could be to improve the diagnostic accuracy of urine cytology.