Voided Urine Fluorescence In Situ Hybridization Testing for Upper Tract Urothelial Carcinoma Surveillance
Voided Urine Fluorescence In Situ Hybridization Testing for Upper Tract Urothelial Carcinoma Surveillance
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DOI：
10.1016/j.juro.2010.05.023
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发表时间：
2010-09-01
影响因子：
6.6
通讯作者：
Bagley, Demetrius H.
中科院分区：
文献类型：
--
作者：
Johannes, James R.;Nelson, Eric;Bagley, Demetrius H.
目的：荧光原位杂交技术在移行细胞癌筛查中的应用日益广泛。材料和方法：回顾2005-2008年间我们的上尿路移行细胞癌数据库，发现35例上尿路移行细胞癌患者在办公室常规访问期间提交了尿液标本进行荧光原位杂交。每个患者在抽样后3个月内在手术室接受内窥镜检查。可疑的病变进行了活检和治疗。上、下尿路移行细胞癌经直视、阳性活检或上尿路细胞学检查证实为恶性或高度可疑。结果：35例患者符合纳入标准。共提交了67份荧光原位杂交标本。51例手术评估中确诊为上尿路移行细胞癌，其中23例合并膀胱癌。荧光原位杂交的灵敏度为56%，特异度为80%。对低级别和高级别病变的敏感性分别为68%和67%。28例仅发现上尿路肿瘤，其中2例假阳性，13例假阴性。在这些病例中，敏感性为54%，特异性为78%，而膀胱细胞学的敏感性为18%，特异性为100%。结论：荧光原位杂交法可作为膀胱移行细胞癌监测的辅助手段。但其在上尿路肿瘤监测中的应用价值有限。
Purpose: Fluorescence in situ hybridization is gaining popularity for transitional cell carcinoma screening. We determined the accuracy of fluorescence in situ hybridization for identifying upper tract transitional cell carcinoma.Materials and Methods: A retrospective review of our upper tract transitional cell carcinoma database from, 2005 to 2008 identified 35 patients with upper tract transitional cell carcinoma who submitted voided urine specimens for fluorescence in situ hybridization at commercial laboratory during a routine office visit. Each patient was evaluated endoscopically in the operating room within 3 months of sampling. Suspicious lesions were biopsied and treated. Transitional cell carcinoma in the lower or upper tract was proved by direct visualization, positive biopsy or upper tract cytology read as positive or highly suspicious for malignancy.Results: Of the patients 35 satisfied study inclusion criteria. A total of 67 fluorescence in situ hybridization specimens were submitted. Upper tract transitional cell carcinoma was identified on 51 operative evaluations, of which 23 showed concurrent bladder tumor. For all encounters the sensitivity of fluorescence in situ hybridization was 56% and specificity was 80%. Sensitivity for low and high grade lesions was 68% and 67%, respectively. Only upper tract tumors were noted in 28 patients, in whom there were 2 false-positive and 13 false-negative voided fluorescence in situ hybridization results. In these cases sensitivity was 54% and specificity was 78% compared to the 18% sensitivity and 100% specificity of bladder cytology. Sensitivity for low and high grade upper tract transitional cell carcinoma was 60% and 50%, respectively.Conclusions: Voided fluorescence in situ hybridization has become an adjunct for bladder transitional cell carcinoma surveillance. However, it has limited value for upper tract tumor surveillance.