| Objective: To compare the sensitivities and specificities of fluorescence in situ hybridization (FISH) and cytology for the detection of transitional cell cancer of the upper urinary tract(UT-TCC).Methods: A mixture of fluorescent labeled probes to the centromeres of chromosomes 3, 7 and 17, and band 9p21 was used to detect urinary cells for chromosomal abnormalities. From October 2007 to March 2009,56 patients with suspected UT-TCC and without a history of urothelial neoplasms,were treated in minimally invasive urology center of Shandong Provincial Hospital. All patients underwent urinary tract imaging. The voided urine specimens from these 56 patients were analyzed in this research. FISH analysis was performed before clinical examinations, including cystoscopy, ureteroscopy, and biopsy. Voided urine samples from 20 normal individuals were used to establish the cut-off values. A positive result was defined as the percentage of cells with 2 or more abnormal chromosomes were greater than the cut-off values. If indicated, surgery (nephroureterectomy or ureterectomy) was performed.Results: Of the 56 patients, 26 had histologically proven UT-TCC. The sensitivity of urine cytology for non-muscle-invasive (pTis, pTa, pT1) , invasive (pT2, pT3,pT4) and all tumors was 10% , 43.8% and 30.8% respectively.The sensitivity of FISH for non-muscle-invasive (pTis, pTa, pT1) , invasive (pT2, pT3,pT4) and all tumors was 40% , 81.3% and 65.4% respectively. The sensitivity of urine cytology for low grade and high grade tumors was 16.7% and 42.8% respectively. The sensitivity of FISH for low grade and high grade tumors was 41.7% and 85.7% respectively. FISH was significantly more sensitive than cytology for invasive (p = 0.0412), high grade (p = 0.0412) and all tumors (p = 0.0077). The specificity of cytology and FISH among patients without evidence of UT-TCC and no history of urothelial neoplasms was 90.5% and 85.7%, respectively (p = 1.000).Conclusions: The sensitivity of FISH for the detection of UT-TCC is superior to that of cytology, and the specificity of FISH and cytology for UT-TCC are not significantly different. FISH might contribute to a more reliable and less-invasive diagnostic approach to UT-TCC. |
