Bergman Jonathan, Reznichek Richard C, Rajfer Jacob
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
BJU Int. 2008 Jan;101(1):26-9. doi: 10.1111/j.1464-410X.2007.07183.x. Epub 2007 Sep 10.
To compare the sensitivity and specificity of the UroVysion (Abbott Laboratories Inc., Downers Grove, IL, USA) fluorescent in-situ hybridization (FISH) assay to that of urinary cytology obtained from bladder irrigation during cystoscopic surveillance in patients with bladder carcinoma.
The medical records were retrospectively reviewed for 41 consecutive patients screened at the authors' institution between August 2000 and December 2006 for recurrence of pathologically confirmed bladder cancer. All 162 cytology examinations and 141 FISH assay results obtained from bladder washing were included. Recurrence was determined by cystoscopy, bladder biopsy and upper-tract imaging. Sensitivity, specificity, positive predictive and negative predictive values were assessed using a chi-square distribution with one degree of freedom.
There were 24 men and 17 women (male to female ratio 0.59), the mean (range) age was 56 (33-73) years and the mean follow-up 30 (2-57) months. At the initial diagnosis, 35 of the 41 patients (85%) had superficial tumours (stage <or= T1), while six (15%) had muscle-invasive tumours (stage >or=T2). Twenty-six (63%) had low-grade and 15 (37%) had high-grade tumours. In 16 of 141 (11%) of the FISH assays and 16 of 162 (10%) of the cytological samples that were collected from bladder irrigations, there were too few cells for an adequate analysis. The FISH assay correctly correlated with subsequent cystoscopy, bladder biopsy or upper-tract imaging in 110/125 (88%) cases but not in 15/125 (12%). Cytology correctly correlated with the subsequent evaluation in 112/146 (77%) cases but did not in 34/146 (23%). When the FISH was compared with cytology in this setting, the sensitivity was 77% (30/39) vs 74% (37/50; P > 0.1), the specificity was 93% (80/86) vs 78% (75/96; P < 0.01), the positive predictive value was 83% (30/36) vs 64% (37/58; P < 0.05), and the negative predictive value was 90% (80/89) vs 85% (75/88; P > 0.1), respectively.
The UroVysion FISH assay obtained from bladder washings during cystoscopic surveillance of patients with a history of bladder cancer provides a similar specificity but greater sensitivity than that of cytology for detecting bladder cancer recurrences. Given the better specificity and similar sensitivity of UroVysion compared with urine cytology obtained from bladder washings, a reasonable approach might be to use the UroVysion assay as the primary marker for recurrence, with urine cytology used as a complementary examination.
比较UroVysion（美国雅培实验室公司，伊利诺伊州唐纳斯格罗夫）荧光原位杂交（FISH）检测法与膀胱癌患者膀胱镜监测期间膀胱冲洗液尿细胞学检查的敏感性和特异性。
回顾性分析2000年8月至2006年12月期间在作者所在机构连续筛查的41例经病理证实的膀胱癌复发患者的病历。纳入所有162次细胞学检查结果以及从膀胱冲洗液中获得的141次FISH检测结果。通过膀胱镜检查、膀胱活检及上尿路影像学检查确定复发情况。采用自由度为1的卡方分布评估敏感性、特异性、阳性预测值和阴性预测值。
患者中男性24例，女性17例（男女比例为0.59），平均（范围）年龄为56（33 - 73）岁，平均随访时间为30（2 - 57）个月。初诊时，41例患者中有35例（85%）为浅表性肿瘤（分期≤T1），6例（15%）为肌层浸润性肿瘤（分期≥T2）。26例（63%）为低级别肿瘤，15例（37%）为高级别肿瘤。在从膀胱冲洗液中采集的141次FISH检测中的16次（11%）以及162次细胞学样本中的16次（10%），细胞数量过少无法进行充分分析。FISH检测结果与后续膀胱镜检查、膀胱活检或上尿路影像学检查结果在110/125（88%）的病例中正确相符，而在15/125（12%）的病例中不符。细胞学检查结果与后续评估在112/146（77%）的病例中正确相符，而在34/146（23%）的病例中不符。在此情况下将FISH检测与细胞学检查进行比较时，敏感性分别为77%（30/39）和74%（37/50；P>0.1），特异性分别为93%（80/86）和78%（75/96；P<0.01），阳性预测值分别为83%（30/36）和64%（37/58；P<0.05），阴性预测值分别为90%（80/89）和85%（75/88；P>0.1）。
在膀胱癌病史患者的膀胱镜监测期间，从膀胱冲洗液中获得的UroVysion FISH检测法在检测膀胱癌复发方面与细胞学检查具有相似的特异性，但敏感性更高。鉴于UroVysion与膀胱冲洗液尿细胞学检查相比具有更好的特异性和相似的敏感性，一种合理的方法可能是以UroVysion检测法作为复发的主要标志物，同时将尿细胞学检查用作补充检查。
