Predictive Value of p16 Immunocytochemistry for Detecting Urothelial Carcinoma in Urine Specimen: A Systematic Review and Meta-analysis

Cheng-Chieh Chen ； Chin-Cheng Lee

《台灣實證醫學學會會刊》 8卷2期 (2017/12) Pp. 26-38

https://doi.org/10.6864/EC.201712_8(2).0013

摘要

Background: Urothelial carcinoma (UC) accounts for approximately 90% of all bladder cancers and has a clinical presentation of painless hematuria. Urine cytology is an initial diagnostic approach for patients with hematuria. p16 immunoreactivity is demonstrated in specimens of urothelial carcinoma in situ and high-grade urothelial carcinoma. Objective: The objective of the study is to determine the diagnostic value of p16 immunocytochemistry in urine specimen from patients with suspicion of UC. Materials and Methods: We searched electronic databases of PubMed, ClinicalKey, BioMed Central, Cochrane Library, and Google Scholar for relevant studies. Studies addressing the diagnostic efficacy of p16 immunocytochemistry in urine specimen were included. We excluded review articles and researches using molecular testing for deoxyribonucleic acid or ribonucleic acid. Either prospective trials or retrospective studies were included. English language studies were reviewed. Methodological quality of studies was assessed by using Quality Assessment of Diagnostic Accuracy Studies-2. Data synthesis was conducted with random-effects model. Results: Three studies that fulfilled the defined criteria were retrieved. The meta-analysis of p16 immunocytochemistry in urine specimen for detecting UC generated pooled sensitivity of 0.80 (95% CI, 0.74 to 0.85) and pooled specificity of 0.66 (95%CI, 0.55 to 0.75), respectively. Area under the curve (AUC) of the summary receiver operating characteristic (SROC) plot presents the overall accuracy of a diagnostic test. The SROC curve of p16 produced an AUC of 0.81, which showed that the overall test performance of p16 immunostain rated as good. The meta-analysis also revealed that summary sensitivity and specificity of urine cytology were 0.61 (95% CI, 0.54 to 0.67) and 0.84 (95% CI, 0.75 to 0.91), respectively. Conclusion: Our investigation presents that p16 immunocytochemistry might be an effective diagnostic approach in detecting UC in urine specimen. We would recommend that p16 immunocytochemistry is a triage test for patient with equivocal urine cytology result.

關鍵字

Cyclin-Dependent Kinase Inhibitor p16 ； Cytology ； Urothelial Carcinoma ； Meta-Analysis ； Predictive Value of Tests