Diagnostic Significance of Cytokeratin ۲۰ and p۵۳ as Adjunct Immunocytological Markers in Urine Cytology to Detect Urothelial Carcinomas: A Systematic Review Study

The progression and recurrence of urothelial carcinoma (UC) are correlated with carcinoma in situ and urothelial dysplasia. It is frequently challenging to distinguish dysplasia and carcinoma in situ from reactive atypia only based on histological characteristics. In daily practices, ۲ of the adjunct immunohistochemistry markers (cytokeratin ۲۰ (CK۲۰) and p۵۳) are used in addition to the histology to diagnose carcinoma in situ. This is accomplished by combining histological research results with immunohistochemistry. This systematic review summarizes the current findings on the diagnostic significance of p۵۳ and CK۲۰ as adjunct markers to urine cytology in the detection of UC. A systematic search of the relevant literature was conducted using PubMed, Wiley Online Library, and ScienceDirect databases. After screening for the eligibility criteria, a total of ۱۴ selected articles were reviewed. Data extraction included a total number of samples, specimen samples, type of cells, and outcome parameters (mainly sensitivity and specificity). Urine cytology alone had a sensitivity of ۷۵%-۸۵% and specificity of ۶۶%-۹۵%. CK۲۰ with urine cytology staining showed improved sensitivity and specificity in the range of ۷۷%-۹۴% and ۷۱%-۱۰۰%, respectively; p۵۳ immunostaining with urine cytology showed a sensitivity of ۵۲%-۸۶% and specificity of ۸۰%-۹۸%. The dual staining in combination with urine cytology showed comparatively higher sensitivity and specificity in the range of ۷۰%-۹۰% and ۷۴%-۱۰۰%, respectively. This was more evident for high-grade UC (HGUC). Overall, single or dual staining combined with urine cytology was effective in this detection and can be applied as an adjunct marker in urine cytology.

Keywords:

Cytokeratin ۲۰ , p۵۳ , Sensitivity , Specificity , Urine Cytology , Urothelial carcinoma