专家膀胱癌检测在紧急环境评估（XESA项目）：一项前瞻性，单中心试验。

IF 3.2 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-01-01 DOI:10.1016/j.euros.2024.09.001

Federica Sordelli , Antonio Desai , Filippo Dagnino , Roberto Contieri , Sofia Giuriolo , Marco Paciotti , Vittorio Fasulo , Stefano Mancon , Davide Maffei , Pier Paolo Avolio , Giorgio Da Rin , Federica Maura , Elena Vanni , Davide Federico , Piergiuseppe Colombo , Giovanni Lughezzani , Nicolò Maria Buffi , Paolo Casale , Alberto Saita , Massiomo Lazzeri , Antonio Voza

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引用次数: 0

摘要

背景和目的：膀胱癌（BC）是一个重大的卫生保健挑战，在急诊科（ed）血尿评估中经常被发现。我们的目的是评估Xpert BC检测（BCD）对急诊科血尿患者的临床表现和经济意义，以解决在这种情况下对更有效和准确的诊断工具的迫切需求。方法：我们在某三级大学附属医院急诊科进行了一项前瞻性单中心观察研究。以肉眼血尿为主要就诊原因的患者被纳入研究。在急诊科收集的尿液样本使用Xpert BCD测试进行分析。与尿细胞学（UC）和白光膀胱镜（WLC）等标准诊断方法相比，Xpert BCD检测的主要结果是敏感性、特异性和成本分析。主要发现和局限性：Xpert BCD检测对UC表现出优越的敏感性，特别是在识别高级别肿瘤方面。重要的是，Xpert BCD的实施有可能显著减少不必要的WLC程序的数量，并简化诊断途径。成本分析还强调了在ED环境中采用Xpert BCD的潜在成本节约。结论和临床意义：我们的研究结果强调了Xpert BCD对于彻底改变ED中血尿患者的BC诊断方法的承诺。其更高的灵敏度和效率意味着Xpert BCD有可能改善患者护理，优化资源利用，并减轻与不必要的程序相关的经济负担。患者总结：Xpert膀胱癌检测是一种简单的尿液检测，可检测与膀胱癌相关的五种基因的存在。我们发现，对于因尿血而到急诊科就诊的患者，使用这种检测方法可以比排除或诊断膀胱癌的尿细胞分析（UCA）节省时间和金钱。该测试在检测高级别癌症方面也更敏感。需要更多的研究来证实我们的结果。

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Xpert Bladder Cancer Detection in Emergency Setting Assessment (XESA Project): A Prospective, Single-centre Trial

Background and objective

Bladder cancer (BC) represents a significant health care challenge and is frequently detected during evaluations for haematuria in emergency departments (EDs). Our aim was to evaluate the clinical performance and economic implications of the Xpert BC Detection (BCD) test for patients presenting to the ED with haematuria to address the pressing need for more efficient and accurate diagnostic tools in this setting.

Methods

We conducted a prospective single-centre observational study in the ED of a tertiary university hospital. Patients presenting with gross haematuria as the primary reason for their visit were enrolled. Urine samples collected in the ED were analysed using the Xpert BCD test. The primary outcomes were sensitivity, specificity, and a cost analysis for the Xpert BCD test in comparison to standard diagnostic methods such as urine cytology (UC) and white-light cystoscopy (WLC).

Key findings and limitations

The Xpert BCD test exhibited superior sensitivity to UC, particularly in identifying high-grade tumours. Importantly, Xpert BCD implementation has the potential to significantly reduce the number of unnecessary WLC procedures and streamline diagnostic pathways. The cost analysis also highlighted potential cost savings for Xpert BCD adoption in the ED setting.

Conclusions and clinical implications

Our findings underscore the promise of Xpert BCD for revolutionising the diagnostic approach to BC in the ED for patients with gross haematuria. Its greater sensitivity and efficiency mean that Xpert BCD has the potential to improve patient care, optimise resource use, and alleviate the economic burden associated with unnecessary procedures.

Patient summary

Xpert Bladder Cancer Detection is a simple urine test that detects the presence of five genes associated with bladder cancer. We found that for patients visiting the emergency department because of blood in their urine, use of this test could save time and money over urine cell analysis (UCA) for ruling out or diagnosing bladder cancer. The test was also more sensitive in detecting higher-grade cancers. More research is needed to confirm our results.

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