Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
J Urol. 2010 Sep;184(3):879-82. doi: 10.1016/j.juro.2010.05.023.
Fluorescence in situ hybridization is gaining popularity for transitional cell carcinoma screening. We determined the accuracy of fluorescence in situ hybridization for identifying upper tract transitional cell carcinoma.
A retrospective review of our upper tract transitional cell carcinoma database from 2005 to 2008 identified 35 patients with upper tract transitional cell carcinoma who submitted voided urine specimens for fluorescence in situ hybridization at commercial laboratory during a routine office visit. Each patient was evaluated endoscopically in the operating room within 3 months of sampling. Suspicious lesions were biopsied and treated. Transitional cell carcinoma in the lower or upper tract was proved by direct visualization, positive biopsy or upper tract cytology read as positive or highly suspicious for malignancy.
Of the patients 35 satisfied study inclusion criteria. A total of 67 fluorescence in situ hybridization specimens were submitted. Upper tract transitional cell carcinoma was identified on 51 operative evaluations, of which 23 showed concurrent bladder tumor. For all encounters the sensitivity of fluorescence in situ hybridization was 56% and specificity was 80%. Sensitivity for low and high grade lesions was 68% and 67%, respectively. Only upper tract tumors were noted in 28 patients, in whom there were 2 false-positive and 13 false-negative voided fluorescence in situ hybridization results. In these cases sensitivity was 54% and specificity was 78% compared to the 18% sensitivity and 100% specificity of bladder cytology. Sensitivity for low and high grade upper tract transitional cell carcinoma was 60% and 50%, respectively.
Voided fluorescence in situ hybridization has become an adjunct for bladder transitional cell carcinoma surveillance. However, it has limited value for upper tract tumor surveillance.
荧光原位杂交技术在移行细胞癌筛查中越来越受欢迎。我们确定了荧光原位杂交技术识别上尿路移行细胞癌的准确性。
对我们 2005 年至 2008 年的上尿路移行细胞癌数据库进行回顾性分析，确定了 35 例在上尿路移行细胞癌患者在常规就诊期间于商业实验室进行尿液荧光原位杂交的患者。每位患者均在采样后 3 个月内在手术室进行内镜评估。可疑病变进行活检和治疗。下尿路或上尿路的移行细胞癌通过直接观察、阳性活检或上尿路细胞学检查证实为阳性或高度可疑恶性。
35 例患者符合研究纳入标准。共提交了 67 个荧光原位杂交标本。在 51 次手术评估中发现上尿路移行细胞癌，其中 23 例同时存在膀胱肿瘤。对于所有的检测，荧光原位杂交的敏感性为 56%，特异性为 80%。低级别和高级别病变的敏感性分别为 68%和 67%。在 28 例仅上尿路肿瘤患者中，有 2 例假阳性和 13 例假阴性的尿液荧光原位杂交结果。在这些情况下，敏感性为 54%，特异性为 78%，而膀胱细胞学的敏感性为 18%，特异性为 100%。低级别和高级别上尿路移行细胞癌的敏感性分别为 60%和 50%。
尿液荧光原位杂交已成为膀胱癌监测的辅助手段。然而，它对上尿路肿瘤的监测价值有限。
