Lotan Yair, Bensalah Karim, Ruddell Timothy, Shariat Shahrokh F, Sagalowsky Arthur I, Ashfaq Raheela
Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9110, USA.
J Urol. 2008 Jun;179(6):2164-9. doi: 10.1016/j.juro.2008.01.105. Epub 2008 Apr 18.
The finding of atypical cytology is confusing for clinicians and it represents a management dilemma. We prospectively evaluated the clinical usefulness of fluorescence in situ hybridization assay for treating patients with atypical cytology who are at risk for bladder cancer.
Between May 2006 and June 2007 every patient who underwent cystoscopy and cytology with atypical or suspicious cytology underwent a reflex UroVysion test. A comprehensive review was then performed to evaluate clinical and pathological data on each patient.
The population comprised 50 patients with no history of cancer and 70 who underwent cystoscopy for cancer surveillance. Fluorescence in situ hybridization assay was positive in all patients with cystoscopically visualized lesions whether they did or did not have a history of bladder cancer (positive predictive value 100%). In patients with equivocal cystoscopy and a history of cancer fluorescence in situ hybridization detected all 5 high grade tumors but it was false-negative for a low grade Ta tumor. In patients with equivocal cystoscopy and no prior cancer the positive predictive value was 50% and there was no false-negative assay result. In patients with negative cystoscopy and a history of cancer fluorescence in situ hybridization detected 3 cancers, including bladder carcinoma in situ in 2 and prostate carcinoma in situ in 1. In patients with no prior cancer and negative cystoscopy fluorescence in situ hybridization detected the only cancer (a high grade ureteral tumor) without yielding any false-negative results.
This prospective evaluation of a reflex fluorescence in situ hybridization assay in patients with atypical cytology shows that the assay was unnecessary in patients with obvious tumors on cystoscopy but it was beneficial in patients with equivocal or negative cystoscopy. Fluorescence in situ hybridization assay identified all high grade cancers. It may help avoid unnecessary evaluation in patients with atypical cytology and equivocal or negative cystoscopy, while identifying those who would need further evaluation.
非典型细胞学检查结果会让临床医生感到困惑，这代表着一种管理困境。我们前瞻性地评估了荧光原位杂交检测在治疗有膀胱癌风险的非典型细胞学患者中的临床实用性。
2006年5月至2007年6月期间，每一位接受膀胱镜检查且细胞学检查结果为非典型或可疑的患者都接受了一项反射性UroVysion检测。然后进行了全面回顾，以评估每位患者的临床和病理数据。
该人群包括50例无癌症病史的患者和70例因癌症监测而接受膀胱镜检查的患者。无论是否有膀胱癌病史，所有膀胱镜检查可见病变的患者荧光原位杂交检测均为阳性（阳性预测值为100%）。在膀胱镜检查结果不明确且有癌症病史的患者中，荧光原位杂交检测出了所有5例高级别肿瘤，但对1例低级别Ta肿瘤检测为假阴性。在膀胱镜检查结果不明确且无既往癌症史的患者中，阳性预测值为50%，且没有假阴性检测结果。在膀胱镜检查结果为阴性且有癌症病史的患者中，荧光原位杂交检测出3例癌症，其中2例为原位膀胱癌，1例为原位前列腺癌。在无既往癌症史且膀胱镜检查结果为阴性的患者中，荧光原位杂交检测出了唯一的癌症（1例高级别输尿管肿瘤），且未产生任何假阴性结果。
对非典型细胞学患者进行反射性荧光原位杂交检测的这项前瞻性评估表明，对于膀胱镜检查有明显肿瘤的患者，该检测是不必要的，但对膀胱镜检查结果不明确或为阴性的患者有益。荧光原位杂交检测识别出了所有高级别癌症。它可能有助于避免对非典型细胞学且膀胱镜检查结果不明确或为阴性的患者进行不必要的评估，同时识别出那些需要进一步评估的患者。
