ABSTRACT
Objective:
To analyze the clinical pathologic characteristics of cases with fluorescence in situ hybridization (FISH) positive of exfoliated urothelial
cells, so as to evaluate the clinical utility of FISH in the
diagnosis of urothelial
carcinoma (UC).
Methods:
A total of 271 cases of FISH positive in Department of
Urology of
Peking University First
Hospital from Apr.2012 to Sep.2015 were recruited in this study.Retrospective
analysis was made on their clinical data.For FISH
analysis, labeled probes specific for
chromosomes 3, 7, 17, and the p16 (9p21)
gene were used to assess
chromosomal abnormalities indicative of
malignancy.The positive predict values (PPV) of all the
techniques were analyzed.
Results:
Of the 271
patients, 207 cases were UC, 7 cases were non-UC, and 57 cases were benign
diseases.The PPV of FISH in detecting UC was 76.4%, while the 95%
confidence interval (CI) 71.3% to 81.5%.In the cohort of FISH positive, this value was
similar to that of urinary
cytology (PPV 86.8%, 95% CI 78.5%-95.0%).The PPV of FISH was lower than that of
cystoscopy and
ureteroscopy (PPV 96.1%, 95% CI 91.7%-100.0%).There were significant differences between this study and the PPV of FISH reported abroad (PPV 53.9%, χ2=33.048, P<0.001).Of all the UC with FISH positive,
bladder cancer showed an earlier pathological stage versus renal pelvic
carcinoma and ureteral
carcinoma, with significance (χ2=5.894, P=0.015, and χ2=13.601, P<0.001, respectively).However, no difference was found in the size, pathological stage and pathological grade of
tumors between the urinary
cytology positive group and the urinary
cytology negative group.The rate of high-grade UC in ureteral
carcinoma of FISH positive was 92.3%, much higher than that of ureteral
carcinoma reported domestically.
Conclusion:
The PPV of FISH in detecting UC is higher relatively, with a better clinic value for
Chinese patients.The ureteral
carcinoma with FISH positive obtains a higher pathological grade, which is of great guiding significance for UC.