Clinical utility of fluorescence in situ hybridization improves the sensitivity in the diagnosis of upper urinary tract urothelial carcinoma

To assess the clinical utility of a fluorescence in situ hybridization (FISH) assay as a non-invasive method for diagnosing and monitoring urothelial carcinoma (UC) in the upper urinary tract (UUT).Urine specimens from 63 consecutive patients with UUT-UC and 69 controls with benign disease were analyzed by means of cytology and FISH. For FISH analysis, labeled probes specific for chromosomes 3, 7, and 17 and for the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.Sensitivity and specificity of both techniques were determined and compared. The frequency of chromosomal aberrations of malignant cells from UUT-UC was also determined.Of 63 patients with UUT-UC, FISH affords an overall sensitivity of 84.1% (53/63), the figure being 71.4% (20/28) for PTa and PT1 tumors,94.3% (33/35) for PT2-4 tumors. The sensitivities of urine cytology were 35.7% (10/28) for PTa and PT1 tumor,45.7% (16/35)for PT2-4 tumors,with an overall sensitivity of 41.3% (26/63). The sensitivities of the two methods for the low grade tumors were 80% (20/25) and 44% (11/25), and for high grade tumors were 86.8% (33/38) and 39.5% (15/38), respectively. Specificities for FISH and urine cytology were 91.3% (63/69) and 94.2% (65/69)respectively.According to the results,the sensitivity of FISH for the detection of UUT-UC is superior to that of urine cytology and the specificities of FISH and urine cytology are not significantly different. FISH can promote the diagnosis of UUT-UC, especially for the low stage and low grade cases,it may be a new promising non-invasive method for the diagnosis of UUT-UC.PubMed04381-54