Value of multicolour fluorescence in situ hybridisation (UroVysion) in the differential diagnosis of flat urothelial lesions.

AIMS: During the past 10 years, multitarget fluorescence in situ hybridisation has been established as a valuable adjunct in the cytological diagnosis of precancerous and malignant lesions of the urinary tract. The aim of the present study was to define its value in detecting chromosomal imbalances in patients with various flat urothelial lesions in routine paraffin-embedded bladder biopsy samples. In addition, the HER2 gene amplification and HER2 expression pattern were examined, since alterations of the HER2 expression patterns have been demonstrated in invasive bladder cancer. METHODS: 29 samples of normal urothelium and 86 flat urothelial lesions (hyperplasia, reactive atypia, dysplasia and carcinoma in situ (CIS)) from 73 patients were analysed patients using tissue microarrays and centromeric probes for chromosomes 3, 7 and 17, and gene-specific probes for 9p21/P16 and HER2 (UroVysion, PathVysion). The expression of HER2 was studied by immunohistochemistry. RESULTS: Polysomy of at least one of the chromosomes was found in about half of the dysplastic cells, and in more than 90% of cells in CIS or cells in invasive bladder tumours. Polysomic cells were found in only 17% of urothelial hyperplasia, reactive atypia and normal urothelium of healthy patients, whereas about 30% of non-neoplastic lesions in patients with concomitant urothelial carcinoma showed polysomy of at least one chromosome. These alterations indicate a field effect and are associated with synchronous development of dysplastic lesions of a higher grade. Deletion of the P16 locus was most frequently observed in aneuploid lesions, whereas overexpression of HER2 was found in 10-20% of invasive urothelial carcinomas, and only occasionally in CIS (5%). An altered HER2 expression pattern was present in non-neoplastic lesions (25%). CONCLUSIONS: UroVysion fluorescence in situ hybridisation is a valuable tool for the detection of genetically unstable flat urothelial lesions, and can help to resolve difficult cases, particularly the differential diagnosis of reactive atypia and dysplasia.

[FISH analysis in the differential diagnosis of flat urothelial lesions using tissue microarrays]. / FISH-untersuchungen an Multi-Tissue-Arrays zur Differenzierung flacher Läsionen des Urothels.

AIMS: FISH technology offers an additional tool in the diagnosis of precancerous and malignant lesions of the urinary tract from cytological specimens. Here, we examined the relevance of chromosomal imbalance in flat urothelial lesions using FISH on paraffin-embedded tissue. In addition, the status of Her2/neu and STK15, a key molecule in the development of aneuploidy, was evaluated. METHODS: Flat lesions (normal urothelium, hyperplasia, reactive atypia, dysplasia and Carcinoma in situlCis) of 73 patients were analyzed in respect of chromosome 3, 7, 17 polysomy, deletion of p16, status of HER2/neu and of STK15 by FISH (UroVysion, PathVysion, Vysis) and immunohistochemistry (HercepTest, DAKO) using tissue microarrays. The data were correlated with histology. RESULTS AND CONCLUSIONS: Aneusomy of at least one of the chromosomes usually correlates with the histology of carcinoma in situ or invasive tumor growth. Reactive atypias, rarely showing chromosomal imbalance, can be distinguished from Cis in the majority of investigated cases, but the FISH technique is not able to differentiate reactive atypia from mild dysplasia. About 30 % of the non-neoplastic lesions like urothelial hyperplasia and normal urothelium display polysomy of at least one chromosome in more than 20% of all cells, indicating an elevated risk towards a synchronous development of a higher dysplastic lesion (i.e. Cis). Polysomy of one of three investigated chromosomes (3, 7, 17) occurs randomly within all lesions. A deletion of the p16 locus is most frequently observed in aneuploid lesions. Altered Her2/neu expression patterns are frequently observed in malignant and dysplastic lesions but also in 25 % of the non-neoplastic lesions. An overexpression of Her2/ neu is found in 10-20% of invasive urothelial carcinomas and occasionally in Cis (5 %). However, the Her2/neu gene locus is not amplified in these samples. Gene amplification of STK15 was seen in tumors as well as in normal urothelium but it is still unclear whether it indicates an elevated risk towards the development of manifest urothelial tumors.