Objectives. To evaluate a combined analysis approach that involves cytologic evaluation and fluorescence in situ hybridization analysis (FISH) for detecting urothelial carcinoma (UC) in the upper tract (UT).
Methods. By refining the UroVysion positive criteria, an analyzing modality (Cyto-FISH) combined urine cytology and FISH analysis (UroVysion probe set) was introduced and urine specimens from 71 patients with UT-UC and 45 controls were analyzed. Sensitivity and specificity of urine cytology, FISH and Cyto-FISH were determined and compared, respectively. The features of chromosomal aberrations of malignant cells from UT-UC were also determined.
Results. Overall sensitivity of verified UT-UC by Cyto-FISH analysis was sharply higher than the single value for urine cytology (85.9% vs. 45.1%, p<0.001) and was slightly higher than FISH (85.9% vs. 78.9%, p=0.378). Sensitivities of cytology and Cyto-FISH by grade were 28.2% versus 74.4% for low grade (p<0.001), and 65.6% versus 96.9% for high grade tumors (p=0.003), respectively.The advantage maintain stably not only in the detection of non-muscle-invasive tumors but in invasive tumors between cytology and Cyto-FISH (39.1% vs. 76.1%, p=0.001, and 53.8% vs. 100%, p<0.001, respectively). Specificities were 97.8%. In addition, polysomic chromosomal aberrations of the UT-UC cases could present a possible trend toward greater chromosome increased with tumor grades and progressive stages of invasion.
Conclusions. Our results have shown that Cyto-FISH analysis for the presence of UC cells is a powerful tool, providing high sensitivity and specificity, and may offer a new scheme for the tough UUT UC diagnosis.