Üriner Şikâyeti Olan Hastalarda İdrar Sitopatolojisi İle Mesane Kanseri Araştırılması

Yıl 2009, Cilt: 66 Sayı: 4, 169 - 176, 01.12.2009

Serpil Oğuztüzün Murat Kılıç Meral Atay Ülkü Güçlütürk Latif Öztürk Zuhal Yazıcı Gökbulut Müzeyyen Özhavzalı Ümit Yırtıcı

Öz

Amaç: Bu çalışmanın amacı, üriner şikâyeti olan hastalarda mesane kanserinin taranması ve idrar sitopatolojisinin öneminin araştırılmasıdır.Yöntem: Kanser tanısı almış 36 hasta ile üriner sistem şikayetleri bulunan 40 yaş üstü 74 hastaya ait toplam 110 idrar örneği filtre yöntemiyle Hannover/Almanya Sitopatoloji Laboratuvarında retrospektif olarak incelenmiştir. Örnekler PAP ile boyanmış ve sonuçlar kikare yöntemleriyle değerlendirilmiştir.Bulgular: Kanser tanısı almış 36 hastanın tamamına 20 papiller ürotelyal karsinom, sekiz yassı epitel hücreli karsinom ve sekiz adenokarsinom sitopatolojik olarak da karsinom tanısı konulabilmiştir. Üriner sistem şikâyetleri olan hastaların 16’sı normal, 23’ü metaplazi–inflamasyon, 35’i şüpheli displazi 10 hafif, 12 orta, 13 ağır olarak değerlendirilmiştir. Üriner şikâyeti olan p=0.013 ve kanser p=0.004 hastalarının yaşları ile sitopatolojik bulguları arasında istatistiksel olarak anlamlı ilişki bulunmuştur. Ayrıca cinsiyet ile sitopatolojik tanı arasında kanserli hastalarda anlamlı bir ilişki belirlenmesine p=0.000 karşın üriner şikâyeti olanlarda anlamlı bir ilişki saptanamamıştır p=0.112 .Sonuç: İdrar sitolojisi, mesane karsinomlarının metaplazi ya da şüpheli basamaklarından birinde yakalanarak erken tanı ile tedavisinin sağlanmasında ve takibinde önemli bir yöntemdir. İdrar sitolojisinin noninvaziv, tekrarlanabilir, ucuz ve kolay bir yöntem olması nedeniyle üriner sistem şikâyeti olan 40 yaş üstü hastalarda tarama amacıyla uygulanması önerilir

Anahtar Kelimeler

İdrar, mesane kanseri, sitopatoloji, filtre yöntemi

The Investigation of Bladder Cancer by Urinary Cytopathology in Patients with Urinary Complaints

Öz

Objective: The aim of this study is to investigate the importance of urine cytopathology and bladder cancer in patients with urinary complaints. Method: A total of 110 urine cytology specimens from 36 diagnosed bladder cancer patients and 74 patients with urinary complaints were prepared by filter technique at Hannover/Germany Cytopathological Laboratory and evaluated retrospectively with a suspicion of bladder carcinoma. The specimens were stained by the PAP method and the results were analyzed by the chi-squared test. Results: All of the 36 bladder cancer patients 20 as papiller urothelial, 8 squamous cell and 8 adenocarcinomas were diagnosed as such cytologically as well. The 16 of the patients with urinary complaints have been diagnosed as normal, 23 as metaplasia–inflammation, 35 as suspicious dysplasia 10 mild, 12 moderate, 13 severe . There have been significant relationship between the ages and cytopathological results of those patients with urinary complaints p=0.013 and those with bladder carcinoma p=0.004 . Moreover, there has been significant relationship between sex and cytopathological findings in the patients with bladder carcinoma p=0.000 , but not in those with urinary complaints. p=0.112 .Conclusion: Urine cytology is an important method for the detection of metaplasia or suspicious cases at early stage and for the treatment and follow-up of the bladder carcinoma cases. It is recommended to use the urine cytology method which is low cost and easily accessible, and can be used noninvasively for the diagnosis and control of patients with urinary complaints

Anahtar Kelimeler

Urine, bladder cancer, cytopathology, filter technique

Kaynakça

• Parker SL, Tong T, Bolden S, Wingo PA; Cancer statistics. CA Cancer J Clin1997; 47: 5–27.
• Messing EM, Catalona W: Urothelial tumors of the urinary tract: Campbell’s Urology 7th edt. Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds.), Saunders WB, Philadelphia 1998; S:2327–410.
• Cohen MS, Johansson SL: Epidemiology and etiology of bladder cancer. Urologic Clinics of North America 1992;19(3):421–8.
• Clavel J, Cordier S, Boccon-Gibod L, Hemon D: Tobacco and bladder cancer in males: Increased risk for inhales and smokers of black tobacco. Int J Cancer 1989; 44: 605–10.
• Carroll PR: Urothelial carsinoma. Cancers of the bladder ureter and renal pelvis: Smith’s General Urology. 14th ed. Tanagho EA, McAninch JW (ed) Prentice-Hall International Inc, Connecticut, 1995: S:353– 71.
• Papanicolaou GN, Marshall VF. Urine sediment smears as a diagnostic procedure in cancers of the urinary tract. Science 1945;101:519–20.
• Mc Kee G, Trott P. Urinary tract cytology. In: Gray W (eds.) Diagnostic Cytopathology: Churchill Livingstone, New York 1995; 468–75.
• Badalament RA, Hermansen DK, Kimmel M. The sensitivity of bladder wash flowcytometry, bladder wash cytology and voided cytology in the dedection of bladder carcinoma. Cancer 1987;60: 1423–27.
• Brown FM. Urine cytology: Is it still the gold standard for screening? Urol Clin North Am 2000; 27(1): 25–37.
• Garbar C, Mascaux C and Wespes E. Is urinary tract cytology still useful for diagnosis of bladder carcinoma. A large series of 592 bladder washings using a fivecategory classification of different cytological diagnoses. Cytopathology 2007; 18: 79–83.
• Touijer AK, and Dalbagni G. Role of voided urine cytology in diagnosing primary urethral carcinoma. Urology 2004; 63: 33–5.
• Planz B, Jochims E, Deix T, Caspers HP, Jakse G, Boecking A. The role of urinary cytology for detection of bladder cancer. EJSO 2005; 31: 304–8.
• Marwah S, Devlin D, Dekker A. A comparative cytologic study of 100 urine specimens processed by the slide centrifuge and membrane filter techniques. Acta Cytol 1978; 22: (5), 431–4.
• Koss LG. Tumors of the urinary tract and prostate. In: Koss LG ed. Diagnostic Cytology and its histopathologic bases: JB Lippincott, Philadelphial, Fifth edition, 2005.
• Murpy WM. Urological Pathology: 2nd ed. USA, Saunders Company, 1997.
• Oğuztüzün S, Aydın M, Çakmak ZA, Kılıç M, et al. The cytological evaluation of bladder and lung carcinoma rates on the workers exposed to industrial chemicals. Turkish Bulletion of Hygiene Experimental Biology 2009; 66 (2): 49-58
• Mc Kee G, Trott P. Urinary tract cytology. In: Gray W (eds.). Diagnostic Cytopathology: Churchill Livingstone, New York 1995; 474 – 5.
• Badalament RA, Hermansen DK, Kimmel M. The sensitivity of bladder wash flowcytometry, bladder wash cytology and voided cytology in the dedection of bladder carcinoma. Cancer 1987; 59: 2078 – 85.
• Canöz Ö, Soyuer I, Öztürk F, Deniz K. İdrar sitolojilerinin istatistiksel analizi ve histolojik tanılarla karşılaştırılması. Erciyes Med. J 2002; 24 (4): 164 – 6.