細胞診による膀胱腫瘍術後の評価

Abstract

膀胱腫瘍術後の20例を対象に, 細胞診を主体とした術後評価をおこなった.初回の治療としておもにTURと術後ADM膀注療法を施行した.術後細胞診陽性例は13例で, 多発性, 最大径1 cm以上, high gradeおよび浸潤性発育の腫瘍に陽性例が多く見られた.Grade 3とStage pT2の症例は全例が術後細胞診陽性で, うち約半数に残存腫瘍組織を確認した.術後細胞診陽性, 生検組織診療性例は, 術後の抗癌剤膀注療法で細胞診の陰性化が見られた.検体の比較では, 膀胱洗滌液が新鮮尿に比べて高い細胞診陽性率を示したが, 新鮮尿にも意義を認めた

In this preliminary report the usefulness of cytological examinations is emphasized in any follow-up for bladder cancer after surgery. In this study, 20 cases of bladder cancer, 3 of which were initially treated by TUC , 16 by TUR, and one by segmental resection, were followed-up regularly by consecutive cytologies, cystoscopy, and biopsies. Anti-cancer drugs were instilled intravesically after the initial surgery in 16 cases. Cytological examinations one month after surgery gave negative results in 7 cases and positive results in 13 cases; cancer cells were confirmed by means of surgical specimens or biopsy in 6 of the latter cases. Positive cytology was documented in 7/9 cases of multiple tumors, in 10/13 cases of tumors larger than 1 cm in diameter, in 7/7 cases of grade 3 tumors, and in 9/9 cases of tumors more advanced than pTa. Positive cytology and negative biopsy were converted to negative in 7 cases by vesical instillation therapy, even in 4 cases with grade 3 tumors and in 2 cases with pT2 . In 6 cases with histologically proved cancer, urine cytology was positive or suspicious in 37.5% (positive in 25.0%) and vesical washing cytology was positive or suspicious in 71.1% (positive in 44.4%). In 7 cases with positive cytology and negative biopsy, urine cytology was positive or suspicious in 20.6% (positive in 7.7%) and vesical washing cytology was positive or suspicious in 70.8% (positive in 43.6%). The above results reveal that in diagnosing cancer in the bladder, washing-fluid cytology is superior to conventional urinary cytology.(ABSTRACT TRUNCATED AT 250 WORDS)