尿中細胞診の診断的価値の検討 --泌尿器科入院患者を中心として--

Abstract

Since Papanicolaou's first report in 1945, urinary cytodiagnosis has been highly evaluated as one of the diagnostic aids of the urinary tract tumors. Clinical application of this method has been naturally limited to the tumors of urothelial origin, but some investigators advocated its usefulness even in renal cell carcinoma and prostatic cancer. Besides, its role in the screening of occupational bladder cancer and in the postoperative follow-up examination of the urinary tract tumors have been mentioned. The author performed cytologic study of urine in 166 patients hospitalized in Urology Department in order to investigate incidence of the pseudonegatives in the tumor group and of the pseudopositives in the non-tumor group. In bladder tumor cases, cytological findings were correlatively studied with duration of symptoms, size and shape of tumor surface, location of tumor, histological malignancy and frequency of cytodiagnosis. Since Papanicolaou's report, over-all pseudopositive rate is 11.1 %, namely diagnostic accuracy being 98.9 %, in the non-tumorous diseases; whereas pseudonegative rate is 33 %, diagnostic accuracy being 67 %, in the tumorous diseases. Cytological diagnosis was made on the early morning urine samples of three consequtive days. The patients consisted of 16 non-tumorous (69 %) and 7 tumorous diseases (31 %). Pseudopositive rate was only 0.3 %. It was a case of essential renal hematuria. Nineteen of 29 bladder tumors showed positive cytodiagnosis (66 %). Duration of symptoms had nothing to do with the positive rate. Large tumor, sessile tumor, infiltrative tumor, or tumor with necrotic surface gave high incidence of positive cytodiagnosis. Grading of malignancy correlated well with incidence of positive findings. As to location, tumors at the dome or lateral wall showed the higher positive rate than those around the ureteral orifices. Of course, the more extensive was the tumor, the higher rate of positive cytology was noticed. Out of the tumor group, 40 % was positive on all the occasions, 60 % more than twice, and 66 % at least once. Tumors of the renal pelvis and the ureter always showed high frequency of the positive. Value of cytodiagnosis in these two neoplasms was definitely demonstrated. No malignant cells in urine could be detected in renal cell tumor, testicular tumor, and penile cancer. This was the same in carcinoma of the prostate even after the massage. As conclusion, cytodiagnosis of urine is useful especially in the urinary tract tumors located in the areas beyond the reach of cystoscope, namely in the renal pelvis, ureter and diverticulum of the bladder. It is also applicable as one of the postoperative follow-up methods of the urinary tract tumors.