Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Urol Oncol. 2012 May-Jun;30(3):273-7. doi: 10.1016/j.urolonc.2010.02.012. Epub 2010 May 6.
The clinical utility of urine markers in urothelial cancer (UC) surveillance is not established. We previously evaluated the use of fluorescence in situ hybridization (FISH) in managing patients with atypical cytology at risk for UC. This study evaluates its role in patients with negative cytology with a history of UC.
Between June 2007 and January 2009, every patient with a history of UC who underwent cystoscopy and cytology with UroVysion test were identified. A comprehensive chart review was performed on each patient with negative cytology.
The population comprised 142 patients undergoing cancer surveillance; 111 patients with negative cystoscopy, 19 with equivocal cystoscopy, and 12 with positive cystoscopy. In patients with negative cystoscopy, there was cancer in only 1 of 111 patients. UroVysion could detect the only patient with UC with sensitivity of 100% and had a negative predictive value (NPV) of 100%. In patients with equivocal cystoscopy, it detected 2 tumors that would be missed by cytology. There were 4 false negative results (sensitivity 33.3% and NPV 66.7%). In patients with obvious lesion on cystoscopy, there were 9 false negative results (sensitivity 10% and NPV 18.2%).
Few patients with negative cystoscopy and negative cytology have cancer. Patients with equivocal and positive cystoscopy and negative cytology frequently have cancer and the UroVysion FISH assay was not helpful in these cases. The cost-effectiveness of the FISH assay needs to be assessed prior to widespread use in patients with negative cytology.
尿液标志物在尿路上皮癌（UC）监测中的临床实用性尚未确定。我们之前评估了荧光原位杂交（FISH）在管理有 UC 风险的非典型细胞学患者中的作用。本研究评估了其在 UC 病史且细胞学阴性患者中的作用。
在 2007 年 6 月至 2009 年 1 月期间，确定了每一位接受过膀胱镜检查和细胞学检查（使用 UroVysion 检测）且有 UC 病史的患者。对每位细胞学阴性的患者进行了全面的病历回顾。
该人群包括 142 名接受癌症监测的患者；111 例膀胱镜检查阴性，19 例膀胱镜检查结果不明确，12 例膀胱镜检查阳性。在膀胱镜检查阴性的患者中，仅有 1 例患者患有癌症。UroVysion 的检测灵敏度为 100%，阴性预测值（NPV）为 100%，仅能检测到 1 例 UC 患者。在膀胱镜检查结果不明确的患者中，它检测到了细胞学可能会遗漏的 2 个肿瘤。有 4 例假阴性结果（灵敏度 33.3%，NPV 66.7%）。在膀胱镜检查有明显病变的患者中，有 9 例假阴性结果（灵敏度 10%，NPV 18.2%）。
膀胱镜检查和细胞学检查均为阴性的患者中，癌症的发生率较低。膀胱镜检查结果不明确和阳性且细胞学检查阴性的患者中，癌症的发生率较高，而 UroVysion FISH 检测在此类情况下并无帮助。在广泛应用于细胞学阴性的患者之前，需要评估 FISH 检测的成本效益。
