Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer.
OBJECTIVE
The UroVysion fluorescence in situ hybridization assay (UroVysion Bladder Cancer Recurrence Kit, Vysis, Inc., Downers Grove, Illinois) is a multi-target assay that detects aneuploidy of chromosomes 3, 7 and 17, and loss of the 9p21 band in exfoliated cells in urine from patients with transitional cell carcinoma. We performed 2 multicenter trials. In 1 trial we compared the sensitivity of the FISH assay to the BTA Stat test (Bion Scientific, Redmond, Washington) and voided cytology in the detection of transitional cell carcinoma. In a separate study of healthy volunteers and patients with other (nontransitional cell carcinoma) conditions we determined the specificity of the FISH assay.


METHODS
A total of 176 patients with transitional cell carcinoma in the previous 9 months provided voided urine before cystoscopy. Each specimen was split, preserved and shipped to a central laboratory where all 3 tests were performed. All sites were blinded to results. Sensitivity calculations were based on central pathology review of resected tissue. Specificity was determined by testing 275 volunteers who were healthy and with nontransitional cell carcinoma conditions.


RESULTS
The 21 sites enrolled 176 patients with a history of transitional cell carcinoma, with 62 recurrences while undergoing surveillance. Overall sensitivities (with 95% CI) were FISH 71% (95% CI 58 to 82), BTA Stat test 50% (37 to 63) and cytology 26% (16 to 39). FISH was negative in 260 of the 275 healthy volunteers or patients with no history of transitional cell carcinoma (specificity 94.5%).


CONCLUSIONS
Sensitivity of the FISH assay is superior to that of cytology and at least equivalent to the BTA Stat test in detecting recurrent transitional cell carcinoma. Its specificity approaches that of cytology. Further testing of its clinical use is warranted.
Sarosdy
Michael F
MF
South Texas Urology and Urologic Oncology, San Antonio 78229, USA.
Schellhammer
Paul
P
Bokinsky
Gary
G
Kahn
Paul
P
Chao
Roberto
R
Yore
Lawrence
L
Zadra
Joseph
J
Burzon
Daniel
D
Osher
Gerald
G
Bridge
Julia A
JA
Anderson
Steven
S
Johansson
Sonny L
SL
Lieber
Michael
M
Soloway
Mark
M
Flom
Kerry
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000782:Aneuploidy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D002869:Chromosome Aberrations; D002874:Chromosome Mapping; D003558:Cystoscopy; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000235:genetics / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D014556:Urine / Q000166:cytology