Utility Of Fluorescence In Situ Hybridization In The Diagnosis Of Upper Urinary Tract Tumors

ObjectiveFor FISH analysis, labeled probes specific for chromosomes 3,7,17 and for the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy. To investigate the clinical utility of fluorescence in situ hybridization (FISH) assay as a non-invasive method for diagnosing and monitoring early upper urinary tract carcinoma. For clinical early diagnosis on urothelial carcinoma and on urothelial carcinoma postoperative follow-up.MethodsUrine specimens from 20 healthy persons were collected from January 2009, For FISH analysis, labeled probes specific for chromosomes 3,7,17 and for the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy. Through the statistical analysis establish normal threshold. Subsequent Urine specimens from 20 consecutive patients with transitional cell cancer of the upper tract (UT-TCC) were analyzed by means of FISH and cytology. Urinary ultrasonic and MMCT were also used in these patients. Compare FISH detection results and other inspection results. Through the statistical analysis compare the similarities and differences of various inspection methods sensitivity. According to the patient's examination results for tumor staging and grading. Compare the similarities and differences of FISH and cytology in different taging and grading tumor. Urine specimens from 20 patients who were diagnosed with renal carcinoma were also analyzed by means of FISH and cytology to compare the specificity.Results1. Postoperative pathology results:18 cases were Upper tract urothelial carcinoma,1 case was Renal carcinoma infiltrating Renal pelvis.1 case was chronic pyelitis associated with nephrolithiasis.2. Probe 3,7, p16 and 17 appear abnormal ratio respectively were 50.0%(9/18),66.7%(12/18.) 55.6%(11/18) and 38.9%(7/18)3. The sensitivity of Urinary ultrasonic. MMCT,cytology and FISH were 44.4% (8/18),94.4%(17/18,38.9%(7/18) and 83.3% (15/18)4. The specific of FISH and cytology were 95% and 90%.5. Based on Pathologic stage, the 18 resected tumors were classified as being non-muscle-invssive (PTa, PT1, PTtis) in 7 (38.9%) and muscle-invssive(PT2-4) in 11 (61.1%). The tumor grade was low(G1-2) in 6 (33.3%) and high (G2-3) in 12 (66.7%). For low grade tumor, the sensitivity was no statistical significance between FISH and cytology (P>0.05). For high grade tumor, FISH has a higher sensitivity in FISH than cytology (P< 0.05).The sensitivity was no statistical significance between FISH and cytology in both non-muscle-invssive tomors and muscle-invssive tumors (P> 0.05)6. The sensitivity between FISH and MMCT are similar (P>0.05). Superior to Urinary ultrasonic and cytology (P<0.05). FISH and cytology are similar in specific (P>0.05)ConclusionsFISH has high sensitivity and specific in the diagnosis of the upper urinary tract tumors, and can monitor early upper urinary tract tumors, Therefore, FISH can be used as a non-invasive method for diagnosing and monitoring UT-TCC, also can be used on urothelial carcinoma patients postoperative review and follow-up.