The Contrast Study On Comparing Among FISH, Cytology Analysis And Cystoscopy Detection For Bladder Transitional Cell Carcinoma Diagnosis

Objective: To compare the clinical effectiveness of FISH, cytology analysis and cystoscopy detection for malignant hematuria diagnosis so as to provide theoretical foundation for establishing and perfecting hematuria etiology diagnosis processMaterials and methods: In the second hospital of Hebei medical university, the department of urology surgery enrolled 78 haematuria patients (51 male and 27 female) suspicious of bladder transitional cell carcinoma from August 2010 to March 2011, including 3 cases of bladder urothelial carcinoma relapses and 75 cases of no history of bladder carcinoma. All of the patients received FISH detection, cytology analysis and cystoscopy check. A total of 53 patients with pathologically diagnosed bladder transitional cell carcinoma were staged as follow: 6 cases in Ta, 26 cases in T1, 13 cases in T2, 8 cases in T3/T4.For the technique of fluorescence in situ hybridization, fluorescently labeled nucleic acid as a probe combined with the single-stranded nucleic acid of unknown specificity in samples so as to form double-stranded nucleic acid hybridization. The result was calculated in accordance with the fluorescence signal. This technique could detect chromosome aberrations and aneuploidy that showed DNA deletions, amplification, and changes in base from the molecular level. In this study, CSP3/CSP7 centromeric probe was used in FISH detection for the patients with hematuria who also took cystoscopy detection. Based on the urine samples of 20 normal subjects, each probe combined with 100 cells with clear signal in FISH detection according to the protocol. The normal thresholds were established base on the statistical result of the percentage of abnormal cells in different type. The test results of 78 patients were compared with the threshold value for diagnosis. FISH-positive criteria included chromosome 3 and 7 abnormalities, or a complex chromosome abnormality. Meanwhile, all of the patients received urine cytology and cystoscopy detection. The comparison of the sensitivity and specificity among the three diagnostic methods were completed based on the tumor staging results of the surgical specimens or cystoscopy biopsy. Urine samples should be taken before the cystoscopy and urine output should not be too small to affect cell count. If the cystoscopy results and pathological examination after surgery were inconsistent, the results of pathological examination after surgical resection prevailed.Results: The overall sensitivity of FISH testing, urine cytology and cystoscopy for bladder transitional cell carcinoma were 86.8%, 17.0%, 92.5%. No significant difference was observed between FISH and cystoscopy (P> 0.05). There was significant difference between FISH and urine cytology(P <0.05). Tumor stage test results(Ta, T1, T2, T3/T4 )of FISH were 33.3%, 88.5%, 92.3% and 100%. Urine cytology were 0%, 3.8%, 15.4%, 75%. Cystoscopy were 66.7%, 92.3%, 100%, 100%.The overall specificity of FISH testing, urine cytology and cystoscopy for bladder transitional cell carcinoma were90%, 100%, 100%. No significant difference was observed among the three methods (P> 0.05)Conclusions: The sensitivity of bladder transitional cell carcinoma detection is nearly identical between FISH and cystoscopy. There was no significant difference for the specificity among the three methods. FISH is a reliable method for the early diagnosis and postoperative monitoring of bladder transitional cell carcinoma, which could be an important detecting method in clinic.