PD13-05 FLUORESCENCE IN SITU HYBRIDIZATION (FISH) IN THE DIAGNOSIS OF BLADDER AND UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE-INSTITUTION EXPERIENCE

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I1 Apr 2016PD13-05 FLUORESCENCE IN SITU HYBRIDIZATION (FISH) IN THE DIAGNOSIS OF BLADDER AND UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE-INSTITUTION EXPERIENCE Mark Mann, Ryan Cleary, Leonard Gomella, Scott Hubosky, Peter McCue, Demetrius Bagley, Costas Lallas, and Edouard Trabulsi Mark MannMark Mann More articles by this author , Ryan ClearyRyan Cleary More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Scott HuboskyScott Hubosky More articles by this author , Peter McCuePeter McCue More articles by this author , Demetrius BagleyDemetrius Bagley More articles by this author , Costas LallasCostas Lallas More articles by this author , and Edouard TrabulsiEdouard Trabulsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.976AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer (BC) is the second most common urological cancer while upper tract urothelial carcinoma (UTUC) is far rarer with approximately 7000 new cases per year. Urine cytology is the only widespread urinary marker is use but has many limitations including low sensitivity and wide interpreter variability. We evaluated the multi target UroVysion (Abbott Molecular, IL) fluorescence in situ hybridization (FISH) assay for the diagnosis of urothelial cancer (UC) in patients with BC only, UTUC only, and combined BC and UTUC. METHODS A single institution retrospective analysis was conducted comparing sensitivity, specificity, positive predictive value, and negative predictive values. FISH within 6 months of endoscopic evaluation were obtained from outpatient voided urine samples. Our institutional pathology department confirmed disease stage from specimens obtained during endoscopic evaluations for lower tract disease. For upper tract disease, disease was confirmed by retrograde ureteroscopy, biopsies of visual lesions, and site specific upper tract cytology. RESULTS A total of 415 patients submitted voided FISH specimens. Seventy-seven patients after evaluation for UC had no evidence of malignancy. One hundred and seventy-six patients had BC, 65 had UTUC, and 32 had both BC and UTUC. Overall FISH was more sensitive than cytology 54.9% in comparison with cytology 42.2% (p=0.01). However, specificity favored cytology 92.9% compared to 73.5% with FISH (p<0.01). After analyzing BC only patients, the same significant finding of increased sensitivity and decreased specificity was identified. For UTUC, FISH had a trend toward being more sensitive, but it was not significant. For both upper and lower tract disease there was no difference in the sensitivities. Cytology had improved positive predictive value (PPV) over FISH, 76.9% in comparison to 64.6% (p=0.02). Negative predictive value (NPV) also favored cytology 74.2% vs. 64.9% (p = 0.02). When analyzing individual cohorts, cytology had improved PPV for BC alone patients. UTUC showed no difference for PPV and NPV. For both UTUC and BC, NPV was slightly favored for FISH over cytology 93.2% vs. 91.2% (p= 0.03). CONCLUSIONS Voided urine FISH testing does offer a higher detection of UC for BC compared to voided cytology; however specificity was worse. In analysis of the separate cohorts, FISH does not appear to improve detection of UC in patients with either UTUC only or both BC and UTUC. FISH alone should not replace cytology as a standalone urinary tumor assay for detection of UC. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e299 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mark Mann More articles by this author Ryan Cleary More articles by this author Leonard Gomella More articles by this author Scott Hubosky More articles by this author Peter McCue More articles by this author Demetrius Bagley More articles by this author Costas Lallas More articles by this author Edouard Trabulsi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...