Fluorescence in situ hybridization for detecting transitional cell carcinoma:: implications for clinical practice
Fluorescence in situ hybridization for detecting transitional cell carcinoma:: implications for clinical practice
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DOI：
10.1111/j.1464-410x.2005.05826.x
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发表时间：
2005-12-01
影响因子：
4.5
通讯作者：
Wolff, DJ
中科院分区：
文献类型：
--
作者：
Laudadio, J;Keane, TE;Wolff, DJ
为了确定在常规临床实践环境中使用荧光原位杂交（FISH）检测新的和复发的移行细胞癌（TCC）病例的遗传学研究的诊断灵敏度，因为膀胱癌具有复发和进展为侵袭性疾病的显著风险，因此灵敏的监测测试是非常重要的。患者和方法使用UroVysionTM试剂盒（Vysis Inc.，Downers格罗夫，IL，USA）使用FISH对膀胱癌患者进行评估，以评估那些有TCC病史或有可疑症状的患者，并将FISH结果与同时进行的活检和细胞学评估进行比较。在521例FISH检测中，24%为阳性; 84%的FISH检测可同时进行细胞学检查，一致率为78%（6%为阳性，72%为阴性）。对于不一致的病例，21%的病例FISH阳性而细胞学阴性，1%的病例细胞学阳性而FISH阴性。总共有99例FISH检测有并发活检数据。在44例TCC组织学阳性的病例中，32例为FISH阳性，导致总体敏感性（95%置信区间）为73（60-88）%。FISH检测到95%的高级别癌病例，而这17例中只有7例同时进行细胞学评估呈阳性。FISH检测到56%，细胞学检测到32%的低度病变。FISH检测到所有9例组织学阳性的新病例。总体而言，FISH的特异性为65（53-78）%。112例以前的TCC，28有复发，其中22人有阳性FISH result.CONCLUSIONFISH分析检测新的TCC病例，以及复发的敏感性高。从目前的数据来看，FISH在诊断TCC方面比细胞学敏感得多，特异性仅略差。因此，我们建议FISH作为一个有用的初步诊断工具，怀疑新的和复发的TCC患者。
OBJECTIVETo determine the diagnostic sensitivity of genetic studies using fluorescence in situ hybridization (FISH) for detecting both new and recurrent cases of transitional cell carcinoma (TCC) in a routine clinical practice setting, as bladder cancer has a significant risk of recurrence and progression to invasive disease and thus sensitive surveillance testing is very important.PATIENTS AND METHODSFISH was performed using the UroVysion(TM) kit (Vysis Inc., Downers Grove, IL, USA) Consecutive patients were assessed using FISH, both to evaluate those with a history of TCC or with suspicious symptoms, and the FISH results were compared with concurrent biopsy and cytological assessments.RESULTSIn all, 521 consecutive FISH tests from 300 patients were evaluated; 47% had a history of bladder cancer and 53% had suspicious symptoms. Of the 521 FISH tests, 24% were positive; concurrent cytology was available for 84% of the FISH tests, with a concordance rate of 78% (6% were positive for both and 72% were negative by both tests). For the discordant cases, FISH was positive and cytology negative in 21% of cases, and cytology was positive with a negative FISH for 1%. In all, 99 FISH tests had concurrent biopsy data. Of the 44 cases histologically positive for TCC, 32 were FISH-positive, resulting in an overall sensitivity (95% confidence interval) of 73 (60-88)%. FISH detected 95% of cases with high-grade carcinoma, while only seven of these 17 were positive by concurrent cytological assessment. FISH detected 56% and cytology detected 32% of low-grade lesions. FISH detected all nine new cases with positive histology. Overall, the specificity of FISH was 65 (53-78)%. Of 112 patients with previous TCC, 28 had a recurrence; 22 of these had positive FISH results.CONCLUSIONFISH analysis has a high sensitivity for detecting new cases of TCC, as well as recurrences. From the present data FISH is considerably more sensitive and only slightly less specific than cytology in diagnosing TCC. Therefore, we recommend FISH as a useful initial diagnostic tool in patients suspected of both new and recurrent TCC.