Utility Of Fluorescence In Situ Hybridization In The Diagnosis Of Urothelial Carcinoma Of The Bladder

ObjectiveTo evaluate the importance of fluorescence in situ hybridization(FISH) technique in the diagnosis of urothelial carcinoma of the bladder and to compare this technique with color ultrasonography, cytological examination and CT; and analyzing the correlations of chromosome aberration to stage and grade of urothelial carcinoma.MethodsUrine specimens from 20 healthy persons were collected for FISH analysis, labeled probes specific for chromosomes 3,7,17 and for the p 16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy. Through the statistical analysis establish normal threshold. All 100 patients with hematuria were investigated by color ultrasonography, FISH, cytology and CT respectively. Based on diagnosis of biopsy by cystoscopy, compare the sensitivity and specificity of the diagnosis of bladder cancer by various method. And analyzing the correlations of chromosome aberration to stage and grade of urothelial carcinoma.Results1.75 of 100 patients were confirmed bladder TCC by cystoscopy and biopsy, others were glandularcystitis. The total sensitivity of FISH, cytology, color ultrasonography and CT is 82.67%,38.67%,78.67%,69.33%, respectively; the specificity of FISH, cytology, color ultrasonography and CT is 92%,100%,96%, 92%, respectively.2. The campare of sensitivity of FISH with cytology and CT has significant difference (P< 0.05), which has no statistically difference campare to color ultrasonography (P>0.05); The specificity between FISH and cytology, color ultrasonography and CT has no statistically difference (P>0.05)3. The campare of sensitivity of FISH with cytology in the Ta and T1period has significant difference (P< 0.05), which has no statistically difference in the Tis,T2,T3 period (P>0.05); the sensitivity of FISH in the high differentiated carcinoma is 81.25%, which has significant difference campare to cytology (P< 0.05), but has no statistically difference in the low differentiated carcinoma (P>0.05)4. The positive rate of CSP3, CSP7, GLPp16 and CSP17 is 57.33%,57.33%, 70.66%,54.66%, respectively. The abnormality of chromosome 3 and chromosome 7 in the tumor every TNM stage is significant difference statistically (P< 0.05), which is not significant difference between high differentiated carcinoma and low differentiated carcinoma (P>0.05); the abnormality of chromosome 9 and chromosome 17 between high differentiated carcinoma and low differentiated carcinoma is significant difference statistically (P< 0.05), which is not significant difference in the tumor every TNM stage. The combination of 4 probe in the tumor every stage and grade is not significant difference statistically (P>0.05)Conclusions1. The FISH assay has a high sensitivity and specificity in the detection of urothelial carcinoma of the bladder, which also have high sensibilities in the well-differentiated cancer and early pathological stage. The sensitivity of FISH is higher than that of cytology and CT, but similar to color ultrasonography. The specificity of FISH is close to that of cytology, color ultrasonography and CT.2. The abnormality of chromosome 3 and chromosome 7 was significantly associated with the tumor stage, but has no relationship with the tumor grade; the abnormality of chromosome 9 and chromosome 17 was significantly associated with the tumor grade, but has no relationship with the tumor stage. 3. FISH is a simple and noninvasive diagnostic method, especially suitable for screening early bladder cancer in the haematuria patients and monitoring postoperative recurrence of bladder cancer. FISH has important clinical value in the promotion of diagnosis of the early bladder cancer and estimating prognosis of bladder cancer.