Diagnostic Value Of Liquid-Based Cytology,DNA Ploidy And Fluorescence In Situ Hybridization In Upper Tract Urothelial Carcinoma

Objective:To investigate the application value of liquid-based cytology(LBC),DNA ploidy and fluorescence in situ hybridization(FISH)in the diagnosis of upper tract urothelial carcinoma(UTUC).Materials and methods :From January 2013 to June 2021,246 cases with suspected UTUC on CT or MRI imaging in our center were recruited and retrospectively analyzed.Among them,190 cases were pathologically diagnosed as UTUC,43 cases non-tumor lesions and 13 cases other types of tumors.All the 246 cases were examined with LBC of voided urine.Among 190 UTUC cases,135 cases were examined with DNA ploidy analysis,133 cases with FISH.Among 43 cases with non-tumor lesions,34 cases were examined with DNA ploidy analysis,26 cases with FISH.Among 13 cases with other types of tumors,9 cases were examined with DNA ploidy analysis,8 cases with FISH.Take UTUC cases as the case group and non tumor cases as the control group.The diagnostic accuracy of LBC,DNA ploidy and FISH alone or in combination was caculated and compared.The sensitivities of the three methods for different grades of UTUC were calculated and compared,and the receiver operating characteristic(ROC)curve was used to analyze the optimal threshold of the number of aneuploid cells for diagnosing UTUC.Results:The sensitivities of LBC,DNA ploidy and FISH in the diagnosis of UTUC were 44.7%,82.2% and 57.9%,respectively;the specificities were 97.7%,82.4% and 92.3%,respectively.The diagnostic sensitivities of the above three methods for high-grade UTUC were 48.1%,87.7% and 60.7%,respectively,and for low-grade UTUC 25.0%,52.4% and37.5%,respectively.When any one of the three approaches was positive,the diagnostic sensitivity was increased to 93.8%(compared with the three methods when they were used alone,all P<0.05).When any two of them were positive at the same time as the criteria for diagnosing UTUC(both negative or only one positive was regarded as negative),the positive predictive value and specificity of this combined diagnostic method were both 100.0%.The result of ROC curve analysis: The area under the curve(AUC)was 0.876,the optimal threshold corresponding to the largest Youden Index(66.0%)was 3 aneuploid cells,the corresponding sensitivity was 74.8%,and the specificity was 91.2%.Conclusion:1.Urinary LBC,DNA ploidy and FISH all are clinically valuable in the diagnosis of UTUC.2.The combination of the three can effectively improve the sensitivity or specificity of diagnosis,thereby helping to reduce the risk of missed diagnosis or misdiagnosis.3.The three methods all are more sensitive for high-grade UTUC.4.The diagnostic value of DNA ploidy analysis may be greater when the threshold for UTUC diagnosis is set to 3 aneuploid cells.