J Korean Med Sci.  2009 Dec;24(6):1139-1144. 10.3346/jkms.2009.24.6.1139.

The Utility of Fluorescence In Situ Hybridization for Detection of Bladder Urothelial Carcinoma in Routine Clinical Practice

• Kwak KW
• Kim SH
• Lee HM

• KMID: 1783145
• DOI: http://doi.org/10.3346/jkms.2009.24.6.1139

Abstract

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.

Keyword

Bladder Urothelial Carcinoma; Cytology; In Situ Hybridization, Fluorescence

MeSH Terms

Aged
Carcinoma, Transitional Cell/diagnosis/*pathology
Female
Humans
*In Situ Hybridization, Fluorescence/methods
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Urinary Bladder Neoplasms/*diagnosis/pathology
Urine/cytology
Urothelium/*pathology

Figure

• 

  Fig. 1 A case with high-grade T1 (T1G3) urothelial carcinoma, cytology suggestive of malignancy, and positive FISH. Cytology, Pap stain 100×showing clusters of pleomorphic nuclei with large nucleoli, suggestive of malignancy (A). FISH shows four copies of chromosome 3 (red), three copies of chromosome 7 (green) and six copies of chromosome 17 (aqua) (B). Resected tumor (H&E, ×20) demonstrates invasion of lamina propria by high grade tumor (C).

• 

  Fig. 2 A case with high grade Ta (TaG3) urothelial carcinoma, negative cytology, and positive FISH. Cytology, Pap stain 100×showing normal urothelium, negative cytology (A). FISH shows four copies of chromosome 3 (red) and 7 (green), and three copies of chromosome 17 (aqua) (B). Resected tumor (H&E, ×20) shows papillary high-grade tumor confined to epithelium (C).

• 

  Fig. 3 Sensitivity based on histologic stage. FISH, fluorescence in situ hybridization; Superficial, Tis, Ta, and T1 urothelial carcinoma; Invasive, ≥T2 urothelial carcinoma.

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  Fig. 4 Sensitivity based on histologic grade. FISH, fluorescence in situ hybridization; Low, Grade 1 and 2; High, Grade 3.

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