Mesane tümörlü hastalarda re-tur öncesi tümör pozitifliğini öngörmede idrar fibronektin düzeyinin yeri : İdrar sitolojisi ile karşılaştırmalı çalışma
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Mesane kanseri, gelişmiş ülke istatistiklerine göre en sık saptanan kanserler arasında 7. sırada yer almaktadır. Mesane kanseri tanısında altın standart yöntemin sistoskopi ve biyopsi olduğu bilinmektedir. Ancak sistoskopi pahalı ve invaziv bir yöntemdir. Progresyon ve rekürrens olasılığı yüksek mesane tümörlerinde yinelenen TUR, önceki TUR? u takiben 2-6 hafta içinde yapılmaktadır. Yüksek dereceli ve kas invaziv kanserlerde idrardaki fibronektin düzeyinin sitolojik çalışmadaki gibi yüksek oranlarda duyarlı ve özgül olması nedeni ile yinelenen TUR planlanan hasta grubunda kullanımı değerli olmaktadır. Ekstrasellüler matriksin majör glikoproteini olan fibronektinin hücre-hücre adezyonu, morfogenezis, diferansiyasyon, en önemlisi onkojenik transformasyonda rolü olduğu bulunmuştur.Mesane kanserinde salgılanan proteazların etkisi ile fibronektin fragmanlara ayrılmakta ve idrarda artmaktadır. Bu sebeple idrar fibronektini, mesane tümörü için belirteç olarak kullanılabilir. İnflamasyon, benign prostat hiperplazisi, prostat kanseri gibi durumlarda da idrar fibronektin seviyesi artmaktadır.Çalışmamızda yinelenen TUR spesmenlerini öngörmede sitolojik değerlendirmeyi idrar fibronektini ile karşılaştırdık. Sitolojik değerlendirme Ki-kare testine göre yüksek duyarlılık ve özgüllük ile istatistiksel olarak anlamlı bulunurken, idrar fibronektini bakılması düşük duyarlılık ve özgüllük ile Mann Whitney U testine göre istatistiksel olarak anlamsız olarak bulundu.
Abstract
Bladder cancer is the 7th most frequently diagnosed cancer, according to the statistics in developed countries. It?s known that the gold standard diagnostic test for bladder cancer is cystoscopy with bladder biopsy. However, cystoscopy is an expensive and invasive procedure. Second TUR is recommended to be performed within 2-6 weeks after inital TUR when the risk of high progression and recurrence is present. As the urinary fibronectin levels in high grade or muscle invasive bladder tumors have high sensitivity and specificity as determined in cytologic examination, which makes it a valuable tumor marker in the group of patients who are scheduled for second TUR. Fibronectin is major glycoprotein of extracellular matrix and plasma. Fibronectin in extracellular matrix is involved in intercellular adhesions, morphogenesis, differantiation and most importantly in oncogenic transformation. Urinary fibronectin split into fragments and may be found in increased levels in urine due to the effect of proteases released in bladder tumours. Therefore urinary fibronectin may be used as a marker in bladder tumours. The urinary fibronectin levels increase in certain diseases like benign prostatic hyperplasia or prostat cancer as well. In this study the urinary cytology and urinary fibronectin levels were compared as a predictor of cancer detection in second TUR specimens. Urinary cytology was found significant with high sensitivity and specificity according to chi-square test while urinary fibronectin levels were not found as significant according to Mann Whitney U test with low sensitivity and spesificity.
Abstract
Bladder cancer is the 7th most frequently diagnosed cancer, according to the statistics in developed countries. It?s known that the gold standard diagnostic test for bladder cancer is cystoscopy with bladder biopsy. However, cystoscopy is an expensive and invasive procedure. Second TUR is recommended to be performed within 2-6 weeks after inital TUR when the risk of high progression and recurrence is present. As the urinary fibronectin levels in high grade or muscle invasive bladder tumors have high sensitivity and specificity as determined in cytologic examination, which makes it a valuable tumor marker in the group of patients who are scheduled for second TUR. Fibronectin is major glycoprotein of extracellular matrix and plasma. Fibronectin in extracellular matrix is involved in intercellular adhesions, morphogenesis, differantiation and most importantly in oncogenic transformation. Urinary fibronectin split into fragments and may be found in increased levels in urine due to the effect of proteases released in bladder tumours. Therefore urinary fibronectin may be used as a marker in bladder tumours. The urinary fibronectin levels increase in certain diseases like benign prostatic hyperplasia or prostat cancer as well. In this study the urinary cytology and urinary fibronectin levels were compared as a predictor of cancer detection in second TUR specimens. Urinary cytology was found significant with high sensitivity and specificity according to chi-square test while urinary fibronectin levels were not found as significant according to Mann Whitney U test with low sensitivity and spesificity.
Açıklama
Tıpta Uzmanlık tezi
Anahtar Kelimeler
Mesane Kanseri, Re-TUR, Sitoloji, İdrar Fibronektin (BTF), Bladder Cancer, Cytology, Urinary Fibronectin (BTF)
