Application Of Fluorescence In Situ Hybridization In Urothelial Carcinoma（Report Of 283 Cases）

Objective: The clinical data and FISH results of 283 outpatients and inpatients in the Department of Urology of Hubei Hospital of traditional Chinese Medicine from September 2020 to April 2022 were collected.Combined with the results of pathological examination,the clinical significance of FISH was objectively analyzed.The characteristics of sex,age,pathological type,pathological grade,clinical stage and chromosome mutation of urothelial cancer patients with FISH posi tive and complete pathological data were summarized.To explore the relationship between chromosome mutation and pathological type,stage and grade of urothelial carcinoma in patients with FISH positive and confirmed by pathology.Methods: The FISH detection data of 283 outpatients or inpatients from the Department of Urology,Hubei Hospital of traditional Chinese Medicine from September 2020 to April 2022 were collected to explore the sensitivity and specificity of FISH in the detection of urothelial carcinoma,and to summarize the clinical application value of FISH detection.Furthermore,40 patients with malignant tumors with positive FISH results and complete pathological data were selected to sort out the data of sex,age,pathological type,pathologica l grade,stage and chromosome mutation,and to explore the relationship between chromosome mutation and pathological type,stage and grade of urothelial carcinoma in FISH positive patients.Results:1.Among the 283 patients,51 cases were FISH positive,16 cases were false positive,232 cases were negative and10 cases were false negative.The false positives included 4 cases of bladder,1 case of renal pelvis,1 case of ureter（no pathological examination）,4 cases of prostate cancer,1 case of papillary renal cell carcinoma,1 case of inverted urothelial papilloma,2 cases of urinary tract infection,1 case of bladder stone,1 case of neurogenic bladder,5 cases of bladder urothelial carcinoma,2 cases of ureteral carcinoma,2 cases of renal pelvis carcinoma and 1 case of urethral carcinoma.2.The sensitivity and specificity of FISH in the detection of urothelial cancer were 77.8% and 93.3%,respectively,the positive predictive value was 68.6%.3.The sensitivity of FISH in detecting bladder cancer was higher than that of upper urothelial carcinoma,and the sensitivity of high grade tumor was higher than that of low grade tumor.4.The detection of FISH is helpful in the diagnosis of bladder cancer and the differentiation of renal cell carcinoma from renal pelvis carcinoma.5.There were 35 patients with urothelial cancer with positive fish results and complete pathological data,of which 24 males（68.6%）were significantly more than 11females（31.4%）and 32 patients over 60 years old（91.4%）.Of the 35 patients with urothelial cancer,23（65.7%）were bladder cancer,6（17.1%）were renal pelvis cancer,and6（17.1%）were ureteral cancer.6.Fish showed the highest mutation rate of chromosome7 in urothelial carcinoma（91.4%）,the highest mutation rate of chromosome 7 in renal pelvis carcinoma（100%）,and the highest mutation rate of chromosome 3 and 7 in ureteral cancer（100%）.The mutation rate of chromosome3 and 7 was the highest in bladder cancer（8 7.0%）.7.FISH detection of chromosome 3,7,17 and p16 gene mutation rate had no significant difference in different types,stages and grades of urothelial carcinoma,and there was no significant difference in p16 gene mutation types in different types and stages of urothelial carcinoma.Conclusion:1.Fish has high sensitivity and specificity in the detection of urothelial carcinoma,and also has a high detection rate for low-grade tumors.2.The clinical results of FISH should be judged by imaging and endoscopy.3.When the imaging results are in doubt,the results of FISH have a certain reference value.4.The total mutation rate of chromosome and gene in urothelial carcinoma detected by FISH was higher,in which chromosome 7 was the most prone to mutation,and the deletion rate of p16 gene was significantly higher than that of amplification.5.The mutation rate of chromosome 3,7,17 and p16 gene in urothelial carcinoma detected by fish had no significant correlation with tumor type,stage and grade,and the mutation type of p16 gene had no obvious tendency in different pathological types,stages and gr ades of urothelial carcinoma.