FISH, Urine Cytology And Cystoscopy In The Diagnosis And Postoperative Recurrence Monitoring Of Bladder Urothelial Carcinoma

ObjectiveIn order to provide theoretical basis for improving the diagnosis strategy of bladder urothelial carcinoma, we compare the value of fluorescence in situ hybridization (FISH), urine cytology and cystoscopy in the diagnosis of bladder urothelial carcinoma, and the value of the three examinations in the postoperative recurrence monitoring of bladder urothelial carcinoma.MethodPart 1:2478 patients of suspected bladder urothelial carcinoma were included in the study. These patients had symptoms of hematuresis or other related clinical symptoms, and all the patients had completed FISH, urine cytology and cystoscopy. The postoperative pathological diagnosis was regarded as the gold standard. The total sensitivity and specificity of the three examinations in the diagnosis of bladder urothelial carcinoma were compared respectively, and so was the sensitivity of the three examinations for the patients in different stages of bladder tumor.Part 2:82 patients underwent the transurethral resection of bladder tumor (TURBT), and all patients were diagnosed with bladder urothelial carcinoma. FISH, urine cytology and cystoscopy were performed at 3 months,6 months,9 months and 12 months follow-up. The positive detection rates of the three examinations were compared respectively. The differences of the average detection time for positive results of the three examinations were also compared. Finally, the value of FISH technology tested positive in determining the recurrence of bladder urothelial carcinoma was evaluated.ResultPart 1:In the 2478 patients with suspected bladder urothelial carcinoma, the total sensitivity of FISH, urine cytology and cystoscopy were 80.81%,26.65%,88.27% respectively. The total sensitivity of the three examinations was compared with each other, and the differences were statistically significant. The total specificity of FISH, urine cytology and cystoscopy were 90.20%,95.71%,85.66% respectively. The total specificity of the three examinations was compared with each other, and the differences were statistically significant.The sensitivity of FISH in different tumor stage of bladder urothelial carcinoma were 66.96% in Ta stage,78.69% in T1 stage,84.99% in T2 stage and 98.92% in T3/4 stage respectively. The sensitivity of urine cytology in different tumor stage of bladder urothelial carcinoma were 6.09% in Ta stage,16.98% in T1 stage,40.46% in T2 stage and 67.57% in T3/4 stage respectively. The sensitivity of cystoscopy in different tumor stage of bladder urothelial carcinoma were 71.30% in Ta stage,85.25% in T1 stage,99.24% in T2 stage and 100.00% in T3/4 stage respectively. There was no statistical difference in the comparison of the sensitivity of FISH and cystoscopy in the diagnosis of bladder urothelial carcinoma in Ta stage. There were statistical differences in the comparisons of the other two groups. There were statistical differences in the comparisons of the three examinations in the diagnosis of bladder urothelial carcinoma in T1 stage and T2 stage, and the cystoscopy had the highest sensitivity. There was no statistical difference in the comparison of FISH and cystoscopy in the diagnosis of bladder urothelial carcinoma in T3/4 stage. There were statistical differences in the comparisons of the other two groups.Part 2:In the 82 patients diagnosed with bladder urothelial carcinoma after surgery, the positive detection rates of FISH were 0% at 3 months,2.44% at 6 months,6.10% at 9 months and 4.88% at 12 months follow-up. The positive detection rates of urine cytology were 0% at 3 months,0% at 6 months,1.22% at 9 months and 2.44% at 12 months follow-up. The positive detection rates of cystoscopy were 0% at 3 months,0% at 6 months, 2.44% at 9 months and 2.44% at 12 months follow-up. The average detection time for positive results of FISH, urine cytology and cystoscopy were (9.55±2.25) months, (11.00 ±1.73) months and (10.5±1.73) months respectively. There were statistical differences in the comparisons of FISH and the other two examinations. The average detection time for positive results of FISH was shorter than urine cytology and cystoscopy.4 patients relapsed in one year after surgery, and the tumor stage had no progress compared with the first surgery. In T2 stage group,2 cases (accounted for 18.18%) relapsed at 9 months after surgery. The other 2 cases were T1 stage (accounted for 3.57%), relapsed at 12 months after surgery. FISH technology test results of all these 4 patients were positive.ConclusionPresently, cystoscopy still is the gold standard for the preoperative diagnosis and postoperative recurrence monitoring of bladder urothelial carcinoma. FISH has a high sensitivity and specificity for the diagnosis of bladder urothelial carcinoma, and it could be used as an early detection screen for bladder urothelial carcinoma. When the results of FISH technical in the preoperative diagnosis or the postoperative recurrence monitoring were positive, and the results of cystoscopy were negative, close follow-up is required to monitor the occurrence of bladder tumor. The sensitivity of urine cytology of the diagnosis for bladder urothelial carcinoma was lower than the other two examinations, and it could be the supplement of other examinations.