Utility of a modality combining FISH and cytology in upper tract urothelial carcinoma detection in voided urine samples of Chinese patients.
OBJECTIVE
To evaluate a combined analysis approach that involves cytologic evaluation and fluorescence in situ hybridization analysis (FISH) for detecting urothelial carcinoma (UC) in the upper tract (UT).


METHODS
By refining the UroVysion positive criteria, an analyzing modality (Cyto-FISH) combined urine cytology and FISH analysis (UroVysion probe set) was introduced and urine specimens from 71 patients with UT-UC and 45 controls were analyzed. Sensitivity and specificity of urine cytology, FISH, and Cyto-FISH were determined and compared, respectively. The features of chromosomal aberrations of malignant cells from UT-UC were also determined.


RESULTS
Overall sensitivity of verified UT-UC by Cyto-FISH analysis was sharply higher than the single value for urine cytology (85.9% vs 45.1%, P <.001) and was slightly higher than FISH (85.9% vs 78.9%, P = .378). Sensitivities of cytology and Cyto-FISH by grade were 28.2% vs 74.4% for low-grade (P <.001), and 65.6% vs 96.9% for high-grade tumors (P = .003), respectively. The advantage maintains stably not only in the detection of nonmuscle-invasive tumors but in invasive tumors between cytology and Cyto-FISH (39.1% vs 76.1%, P = .001, and 53.8% vs 100%, P <.001, respectively). Specificities were 97.8%. In addition, polysomic chromosomal aberrations of the UT-UC cases could present a possible trend toward greater chromosome increased with tumor grades and progressive stages of invasion.


CONCLUSIONS
Our results have shown that Cyto-FISH analysis for the presence of UC cells is a powerful tool, providing high sensitivity and specificity, and may offer a new scheme for the tough UT-UC diagnosis.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Chuanliang
C
Xu
Qinsong
Q
Zeng
Jianguo
J
Hou
Li
L
Gao
Zhensheng
Z
Zhang
Weidong
W
Xu
Bo
B
Yang
Yinghao
Y
Sun
D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000235:genetics; D002869:Chromosome Aberrations; D003581:Cytodiagnosis; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000235:genetics; D014556:Urine / Q000166:cytology*