Utility of a modality combining FISH and cytology in upper tract urothelial carcinoma detection in voided urine samples of Chinese patients

Abstract

Objectives: To evaluate a combined analysis approach that involves cytologic evaluation and fluorescence in situ hybridization analysis (FISH) for detecting urothelial carcinoma (UC) in the upper tract (UT).

Methods: By refining the UroVysion positive criteria, an analyzing modality (Cyto-FISH) combined urine cytology and FISH analysis (UroVysion probe set) was introduced and urine specimens from 71 patients with UT-UC and 45 controls were analyzed. Sensitivity and specificity of urine cytology, FISH, and Cyto-FISH were determined and compared, respectively. The features of chromosomal aberrations of malignant cells from UT-UC were also determined.

Results: Overall sensitivity of verified UT-UC by Cyto-FISH analysis was sharply higher than the single value for urine cytology (85.9% vs 45.1%, P <.001) and was slightly higher than FISH (85.9% vs 78.9%, P = .378). Sensitivities of cytology and Cyto-FISH by grade were 28.2% vs 74.4% for low-grade (P <.001), and 65.6% vs 96.9% for high-grade tumors (P = .003), respectively. The advantage maintains stably not only in the detection of nonmuscle-invasive tumors but in invasive tumors between cytology and Cyto-FISH (39.1% vs 76.1%, P = .001, and 53.8% vs 100%, P <.001, respectively). Specificities were 97.8%. In addition, polysomic chromosomal aberrations of the UT-UC cases could present a possible trend toward greater chromosome increased with tumor grades and progressive stages of invasion.

Conclusions: Our results have shown that Cyto-FISH analysis for the presence of UC cells is a powerful tool, providing high sensitivity and specificity, and may offer a new scheme for the tough UT-UC diagnosis.