The Contrast Study On Comparing Among Fish, Urine Cytology And Cystoscopy Detection For Urinary Tract Transitional Cell Carcinoma Diagnosis

Objective： Urinary tract transitional cell carcinoma is morecommon tumor of the urinary tract,which is with high incidence ofrecurrence rate and high mortality. The treatment of diseases occupy alot of medical resources. Large amounts of data showed that patientsaccepted more earlier diagnosis and treatment, the prognosis would bebetter. In this study, we compared the clinical effectiveness of fluorescencein situ hybridization (FISH) examination, urine cytology and cystoscopefor malignant hematuria as the main symptoms of urinary tract urinarytract cells in tumor diagnosis. We Provided data for improving thehematuria diagnosis from our study.Materials and methods: In the second hospital of Hebei medicaluniversity, the department of urology surgery enrolled100haematuriapatients (71male and29female,median age61years) suspicious ofurinary tract urothelial tumors,from August2010to august2011. All ofthe patients received FISH,urine cytology and cystoscope.72patients ofthem were pathologically diagnosed as bladder transitional cellcarcinoma, the staging as follow:10cases of Ta,26cases of T1,25casesof T2,11cases of T3/4.13patients were diagnosed as upper urinary tracttumor, including6cases of carcinoma of renal pelvis,6cases of uretercancer and1cases of endocrine carcinoma of the renal pelvis nerve. Theother15cases included2cases of bladder adenocarcinoma,10cases ofcystitis glandularis,1cases of interstitial cystitis,1cases of renaltuberculosis,1cases of prostate cancer.Fluorescence in situ hybridization (FISH) is a molecular geneticstechnology, originated in the late1980s. Probe is a known fluorescently labeled nucleic acid. In accordance with the complementary base pairingprinciple, we combined the probe and unknown single-stranded nucleicacid specificly to form a hybrid double-stranded nucleic acids. Then wecould use fluorescent microscopy to read out the outcome. FISH candetect abnormal number of chromosomes and chromosomal aberrations.The experimental use GLP p16/CSP17combination probe.We used the same method for the urine samples of20normalsubjects(10males,10females)with FISH experiment to establish thethreshold by the statistics of the percentage of different types ofabnormal cells. Threshold=mean (M)+3×standard deviation (SD).Established the17th chromosome≥3signal,p16site0signal point and1point threshold. This threshold was early established in our laboratoryexperiments.(Results see Table1)FISH-positive criteria included chromosome17and9abnormalitiesat the same time, or a complex chromosome17abnormality, or anexception of p16(-2) alone more than15%.100cases of patients alsowere detected by urine cytology and cystoscopy detection. Thecomparison of the specificity and sensitivity among the three diagnosticmethods were completed based on the tumor staging results of theureteroscopic biopsy or surgical specimens (suspicious of urine cytologydiagnosis as the positive results of treatment). Take urine samples beforecystoscopy, not less than200ml, and otherwise affect the cell count. Ifthe results of cystoscopic biopsy and surgical resection pathologicalexamination or pathological staging were inconsistent, the results of thepathology of surgical specimens shall prevail.Results: The overall sensitivity FISH examination, urine cytologyand cystoscopy in72patients with bladder transitional cell carcinomawere62/72(86.1%),14/72(19.1%),67/72(93.1%). Three methodspairwise comparison. FISH and cystoscopy, P=0.057>0.05, nostatistical significance; FISH and urine cytology, P=0<0.05,there wasstatistically significant. Urine cytology and cystoscopy, P=0<0.05, there was statistically significant. The sensitivity of FISH in bladdertransitional cell carcinoma of Ta, T1, T2, T3/4staging were60.0%,86.5%,94.1%,100%;urine cytology were0%,13.5%,23.4%,62.5%;and thecystoscope were80.0%,91.9%,100%,100%, respectively. At Ta, T1, T2stage, compare FISH with urine cytology, P <0.05, there was statisticallysignificant; at T3/4stage, there was not statistically significant. CompareFISH with cystoscopy for eath stage,there was not statisticallysignificant. The specificity of FISH, urine cytology, and urine cytologywere10/12(83.3%),12/12(100%),12/12(100%).There was nostatistically significant of the three.The sensitivity of FISH examination and urine cytology for12cases of upper urinary tract transitional cell carcinoma were12/12(100%),3/12(25.0%), P <0.05, there was statistically significant. Theoverall sensitivity of both tests for the84cases of entire urinary tracttransitional cell carcinoma were74/84(88.1%),17/84(20.2%),respectively, P <0.05, statistically significant. The sensitivity of FISH inthe entire urinary tract transitional cell carcinoma of Ta, T1, T2, T3/4staging were60.0%,86.8%,95.2%,100%,and urine cytology were0%,15.8%,23.8%,40.0%.For each stage, P <0.05, there was statisticallysignificant. The overall specificity of two methods were13/16(81.3%),16/16(100%), P>0.05, not statistically significant.Conclusions: For bladder transitional cell carcinoma,the sensitivityof FISH was equal to cystoscopy,both significantly higher than urinecytology. There was no significant difference in specificity. FISH andurine cytology could detect upper urinary tract transitional cellcarcinoma. For upper urinary tract transitional cell carcinoma, thesensitivity of FISH was significantly higher than urine cytology.Therefore, FISH can be used as an effective means of screening oftransitional cell carcinoma for patients with malignant hematuria as the main symptoms. FISH as an important Method could effectivelydiagnose urinary tract transitional cell carcinoma earlier.