The Diagnostic Value Of Automated DNA Image Cytometry In Urothelial Carcinoma

Objective: Urothelial carcinoma is a common urogenital cancer. It has high rates of recurrence and progress, and needs a long-time follow-up. Automated DNA image analysis can quantify nuclear DNA automatically, and has shown its superiority in many malignant tumors diagnosis. Our study aims to compare urine exfoliated cells’ DNA ploidy of urothelial carcinoma patients with non-urothelial patients, and analyze relevant factors. We will determine the best threshold value of automated DNA image cytometry in urothelial carcinoma diagnosis, its diagnostic value and factors affecting the missed diagnosis.Methods: 116 participants were included in our study from August 2014 to March 2015. 74 of 116 participants were included in urothelial carcinoma group, and 42 of 116 participants were included in non-urothelial carcinoma group. We measured the DNA content of urine exfoliated cells by automated DNA image cytometry, and collected related information. The experimental data were analyzed by SPSS19.0 software.Results: The urothelial carcinoma group had higher distribution ratios of 4N(1.8c≤DI≤2.2c)and 5N(DI>2.2c)and lower distribution ratio of 2N(DI≤1.1c)than non-urothelial carcinoma group(p=0.00,p=0.01, p=0.02). Two groups had similar distribution ratios of 3N(1.1c<DI<1.8c)(p=0.80).Male patients had higher distribution ratio of 5N(DI>2.2c)than female patients(p=0.03),while they had similar distribution ratios of the others(p=0.16,p=0.66,p=0.11).In male patients group, the best threshold was that the DI value was 2.8/2.9c and the proportion of aneuploid cells was 3‰. The sensitivity was 0.71, the specificity was 0.92, and the area under curve was 0.823. In female patients group, the best threshold was that the DI value was 2.5c and the proportion of aneuploid cells was 8‰. The sensitivity was 0.45, the specificity was 0.97, and the area under curve was 0.728. Symptoms affected missed diagnosis in male patients group. Patients with macroscopic haematuria had higher missed diagnosis rate than patients with bladder irritation symptoms and patients with macroscopic haematuria plus bladder irritation symptoms(p=0.04,p=0.01). Patients found by medical examination had similar missed diagnosis rate(p=0.77). In male patients group, high grade urothelial carcinoma patients had lower missed diagnosis rate than low grade urothelial carcinoma patients(p=0.02).Conclusion: Urothelial carcinoma group’s DNA ploidy pattern is different from non-urothelial group, and is affected by gender. Male and female patients have their own threshold, which has a good diagnostic value. Automated DNA image cytometry represents a potent adjunct to diagnose urothelial carcinoma. In male patients group, symptoms and grade affect missed diagnosis rate.