432 APPLICATION OF SELECTIVE FLUORESCENCE IN SITU HYBRIDIZATION (FISH) TESTING IN THE EVALUATION OF UPPER TRACT UROTHELIAL CARCINOMA (UTTCC)

Abstract

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2010432 APPLICATION OF SELECTIVE FLUORESCENCE IN SITU HYBRIDIZATION (FISH) TESTING IN THE EVALUATION OF UPPER TRACT UROTHELIAL CARCINOMA (UTTCC) James Johannes, Marluce Bibbo, Bajaj Renu, and Demetrius Bagley James JohannesJames Johannes More articles by this author , Marluce BibboMarluce Bibbo More articles by this author , Bajaj RenuBajaj Renu More articles by this author , and Demetrius BagleyDemetrius Bagley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.502AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES FISH testing of bladder urine is gaining popularity in bladder cancer screening. Recent reports suggest limited utility of voided FISH specimens for identifying UTTCC. The purpose of this study was to determine FISH testing accuracy of urine sampled directly from the upper tracts versus the bladder. METHODS Beginning in 7/2009, we initiated FISH testing of all upper tract urine samples in suspected UTTCC cases. We performed a retrospective review of our prospectively maintained UTTCC database. All selective urine samples were gathered through the working channel of a flexible ureteroscope, bladder urines via cystoscope. These samples were analyzed by our institutional cytopathologists for cytology and FISH. For FISH testing, the Vysis UroVysion assay kit was used which identifies abnormalities on chromosomes 3, 7, 9, and 17. Any visible tumor was biopsied and treated endoscopically. The presence of UTTCC was proven by either direct visualization, positive biopsy, or cytology read as positive or highly suspicious for malignancy. Retrograde urography (RU) was performed in each patient and interpreted by the operating surgeon. RESULTS A total of 27 consecutive patients underwent endoscopic evaluation for UTTCC. The mean age was 71 and a majority were female (63%). UTTCC was identified in 24 of 27 patients. UTTCC grade was available from biopsy in 14 of 24 patients, 9 of 14(64%) low grade, 5 (36%) were high grade. The overall sensitivity and specificity for the selective upper tract FISH testing was 87.5% and 100% respectively. Cytology yielded a 100% sensitivity and specificity. By contrast bladder cytology and FISH had sensitivities of 39% and 24% respectively. By grade, upper tract FISH testing was 100% sensitive for low grade tumors but 80% sensitive for high grade tumors. Overall RU was 37.5% sensitive, 100% specific. After excluding patients with a positive cytology but no visible tumor, RU was 56% sensitive. CONCLUSIONS FISH testing of selective upper tract urine samples has a sensitivity and specificity similar to cytology. Selective upper tract sampling of FISH and cytology is significantly more sensitive than similar testing of bladder urine in detecting UTTCC. RU is less sensitive than cytology or FISH for detection of UTTCC. Therefore, upper tract urine FISH may be an important addition to direct ureteroscopic examination for UTTCC detection and surveillance. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e171 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Johannes More articles by this author Marluce Bibbo More articles by this author Bajaj Renu More articles by this author Demetrius Bagley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...