Prospective evaluation of FISH for detecting upper tract urothelial carcinoma in voided urine specimens

Abstract

Abstract. The aim of the present study was to estimate the diagnostic value of fluorescence in situ hybridization (FISH) analysis of tumor cells in voided urine specimens for detecting upper tract urothelial carcinoma (UTUC). Cytology and FISH analyses were conducted on voided urine collected in the morning from 125 patients with suspected UTUC. During follow-up, ureteroscopy with biopsy and histopathology were used to confirm the presence of tumors. The average follow-up time was 23.8 months (range, 6-36 months). A total of 8 patients who could not be contacted until the last follow-up were excluded from the study. Of the remaining 117 patients, 19 were histologically demonstrated to have UTUC, of whom, 3 patients had stage pTis disease, 6 had stage pTa disease, 5 had stage pT1 disease and 5 had stage pT2 disease (7 G1, 8 G2 and 4 G3). The overall sensitivity of FISH to detect UTUCs in voided urine specimens was 84.21% (16/19), whereas that of cytology was 42.11% (8/19) (P<0.05). The overall specificity of FISH to detect UTUCs in voided urine specimens was 89.80% (88/98), compared with 94.90% (93/98) of cytology (P>0.05). The positive predictive value (PPV) and negative predictive value of FISH were 80.00% (16/20) and 97.78% (88/90), respectively, whereas those of cytology were 100.00% (8/8) (P>0.05) and 90.29% (93/103) (P>0.05), respectively. The present data indicated that FISH was a method capable of detecting UTUCs in voided urine specimens with good sensitivity and specificity, although it exhibited a high rate of false positivity and low PPV.

The combined application of urinary liquid‐based cytology with fluorescence in situ hybridization and p16/Ki‐67 dual immunostaining is valuable for improving the early diagnosis of upper tract urothelial carcinomas

“…FISH was proven to be a sensitive method to detect bladder tumor as a noninvasive way and successfully used for the detection of molecular abnormalities in UTUCs . A recent study reported that the overall sensitivity and specificity of FISH in detecting UTUCs were 84.21% and 89.80%, respectively . In our study, the sensitivity of FISH in detecting HGUTUCs and LGUTUCs were 69.6% (32/46) and 60% (9/15), respectively.…”

“…1,10 A recent study reported that the overall sensitivity and specificity of FISH in detecting UTUCs were 84.21% and 89.80%, respectively. 30 In our study, the sensitivity of FISH in detecting HGUTUCs and LGUTUCs were 69.6% (32/46) and 60% (9/ 15), respectively. Although FISH and LBC had similar specificity (90.0% vs.94.4%), the sensitivity of FISH in detecting LGUTUCs was higher than that with LBC (33.3%).…”

Upper urinary tract washings outperform voided urine specimens to detect upper tract high‐grade urothelial carcinoma

“…In our larger cohort, we saw that patients with concurrent UW and VU specimens had a more severe diagnosis on UW cytology (21/32, 66%). More recently, Yu et al found that in a slightly larger cohort, the sensitivity of FISH in VU was significantly higher than that of VU cytology (84% vs.42%) for detecting UTUC, though the positive predictive value of FISH was slightly lower.…”

Diagnostic Value Comparison of Urothelium Carcinoma Among Urine Exfoliated Cells Fluorescent In Situ Hybridization (FISH) Examination, Computerized Tomography (CT) Scan, and Urine Cytologic Examination

“…The sensitivity of CT scanning gradually increased with upstaging, which was incommensurable in FISH. However, FISH is noninvasive and can be used as a supplement for CT scan and urine exfoliative cytological examination [ 19 , 20 ].…”