BACKGROUND In general, urine cytology is often problematic because of its low sensitivity, especially for low-grade urothelial carcinoma (UC) in clinical practice. To improve the sensitivity, we focused on 5-aminolevulinic acid (5-ALA), because recent studies suggested that 5-ALA-induced urine cytology can be used for photodynamic diagnosis. In this study, we evaluated the diagnostic efficacy of 5-ALA-induced fluorescent urine cytology for UC. METHODS We included in this study 318 patients comprising 158 non-cancer patients, 84 bladder tumor patients, and 76 upper urinary tract urothelial carcinoma (UUT-UC) patients treated in our institution from March 2013 to September 2018. Using the same voided urine sample, we compared sensitivity and specificity between conventional urine cytology and 5-ALA-induced fluorescent urine cytology. RESULTS Overall, the sensitivity of 5-ALA-induced fluorescent urine cytology was significantly higher than that of conventional urine cytology (86.9% vs. 69.4%; p = 0.0002), and the specificity was equivalently high (96.2% vs. 95.6%; p = 1.0). In subgroup analysis, the high sensitivity of 5-ALA-induced fluorescent urine cytology was also detected regardless of age, sex, and tumor type. However, in terms of stage and grade, differences were only detected in patients with less than pTa stage (89.2% vs. 52.1%; p = 0.0001) and low-grade tumor (91.5% vs. 51.1%; p < 0.0001). CONCLUSIONS 5-ALA-induced fluorescent urine cytology was significantly more effective for UC diagnosis when compared with the conventional cytology, especially in patients with low-stage and low-grade tumors. These findings indicate that 5-ALA-induced fluorescent urine cytology may potentially be a very useful tool for clinical use.

中文翻译：

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5-氨基乙酰丙酸诱导的尿液荧光细胞学检查对尿路上皮癌的高诊断效力。

背景技术通常，由于尿液细胞学敏感性低，特别是对于临床实践中的低度尿路上皮癌（UC），尿液细胞学常常是有问题的。为了提高灵敏度，我们集中研究了5-氨基乙酰丙酸（5-ALA），因为最近的研究表明5-ALA诱导的尿液细胞学可用于光动力诊断。在这项研究中，我们评估了5-ALA诱导的UC荧光尿细胞学的诊断功效。方法我们从2013年3月至2018年9月在本机构接受治疗的318例患者包括158例非癌患者，84例膀胱肿瘤患者和76例上尿路尿路上皮癌（UUT-UC）患者。使用相同的排尿样品，我们比较了常规尿液细胞学检查和5-ALA诱导的荧光尿液细胞学检查的敏感性和特异性。结果总体而言，5-ALA诱导的荧光尿细胞学检查的敏感性显着高于常规尿液细胞学检查（86.9％vs. 69.4％； p = 0.0002），并且特异性同样很高（96.2％vs. 95.6％； p = 1.0）。在亚组分析中，无论年龄，性别和肿瘤类型如何，都可以检测到5-ALA诱导的荧光尿细胞学检查的高灵敏度。然而，就分期和等级而言，仅在pTa分期以下（89.2％vs. 52.1％； p = 0.0001）和低度肿瘤（91.5％vs. 51.1％； p <0.0001）的患者中发现差异。结论与常规细胞学相比，5-ALA诱导的荧光尿细胞学检查对UC诊断显着更有效，特别是在低期和低度肿瘤患者中。