尿路悪性腫瘍における尿細胞診の検討 -膀胱腫瘍を中心として-

Abstract

Exfoliative cytologic studies of the urine were carried out in 126 cases with malignant neoplasmas of the urinary tract (primary bladder tumor: 74 cases, secondary bladder tumor: 25 cases, carcinoma of the prostate: 19 cases, carcinoma of the kidney: 5 cases, and carcinoma of the renal pelvis and ureter: 3 cases), who visited our Kanagawa Prefectural Hospital Center for Adults for the last 5 years during period of 1969-1974, The clinical significance of exfoliative cytologic studies of the urine for detection of malignant tumors and the various factors affecting the results of these studies were evaluated. The rate of positive results for detection of malignancy was as follows; 68.9% in primary bladder tumor, 40% in secondary bladder tumor, 21.1% in carcinoma of prostate, 0% in carcinoma of the kidney, and 100% in carcinoma of the renal pelvis and ureter. In primary bladder tumor, the rate of positive results of exfoliative cytologic study of the urine was higher in the undifferentiated tumors than in the differentiated tumors, but there were no statistically significant differences between these two groups. On the other hand, the rate of positive results of urinary exfoliative cytology was statistically higher in the tumors with larger size than in those with smaller size. It was observed that the more frequently exfoliative cytology of the urine was examined, the higher the rate of positive results became. Therefore, it would be desirable to check the urine for exfoliative cytology more than 4 times per one patient in order to establish a definitive diagnosis of malignancy by this method only. It is our conclusion that exfoliative cytologic studies of the urine are clinically useful method for the detection of carcinoma of the urinary tract, particularly carcinoma of the renal pelvis and ureter and bladder tumor which could not be discovered by cystoscopic examination, such as in situ carcinoma, early bladder tumor, and early recurrent tumors.