Comparison of Urine Cytology and Fluorescence In Situ Hybridization in Upper Urothelial Tract Samples.
Jordan P Reynolds, Jesse S Voss, Benjamin R Kipp, RJeffery J Karnes, Aziza Nassar, Thomas J Sebo, Amy C Clayton, Jun Zhang, Michael R Henry, Kevin C Halling. Mayo Clinic, Rochester, MN
Background: Fluorescence in situ hybridization (FISH) with the Urovysion® probe set (Abbot Molecular Inc., Des Plaines, IL) has been shown to detect chromosomal abnormalities in urine cytology with high sensitivity and specificity for bladder urothelial carcinoma (UC). Surveillance of the upper urinary tract (UT) urothelium remains challenging. The aim of this study is to compare the performance of cytology and FISH in the UT.
Design: UT urine samples (n=112) were collected from 61 patients (48 male, 13 female, mean age 66.2 years) via cysto/ureteroscopy from 2003-2009. Cytologic interpretation and FISH were performed using probes to chromosomes 3, 7, 17 and 9q21. Positive cytologic diagnoses were considered as positive and all other diagnoses were considered as negative. FISH was abnormal when identifying tetrasomy (≥10 cells with 3-4 copies of each probe (TETRA)) or hypertetrasomy/polysomy (≥4 cells with gains in at least two probes with one showing ≥5 signals (HT)). Biopsy diagnosis of UT cancer (n=21) within 2 years of the cytology/FISH result was the gold standard. In cases without a biopsy, a negative urogram or ureteroscopy with at least 1 year of follow up was considered negative (n=91). The mean follow up time was 3.2 years.
|All cases||Cases with bladder UC excluded|
|Cytology||38% 8/21||89% 81/91||50% 7/14||95% 53/56|
|FISH HT||43% 9/21||84% 76/91||50% 7/14||89% 50/56|
|FISH HT & TETRA||67% 14/21||53% 48/91||79% 11/14||52% 29/56|
|FISH HT & Cytology||52% 11/21||77% 70/91||64% 9/14||84% 47/56|