多色荧光原位杂交检测尿沉渣诊断膀胱尿路上皮癌

Utility of a multiprobe fluorescence in situ hybridization assay in the detection of bladder cancer

目的研究应用多色荧光原位杂交检测尿沉渣诊断膀胱尿路上皮癌的可行性,并与尿脱落细胞学相比较。方法M-FISH法分析100例可疑膀胱尿路上皮癌或有相关病史患者和10例良性前列腺增生患者晨尿尿沉渣,同时行尿脱落细胞学检查,以病理为诊断标准。FISH探针是用随机引物法标记3、7、17号染色体着丝粒及9p21区带,统计染色体畸变组合诊断膀胱尿路上皮癌的阳性率。结果M-FISH低级别尿路上皮癌灵敏度75.6%,高级别尿路上皮癌为100%,总体灵敏度85.5%;尿脱落细胞学低级别尿路上皮癌灵敏度33.3%,高级别是96.0%,总体灵敏度62.9%,两者总体灵敏度之间有统计学差异(P<0.05);两者特异性分别是84.6%和87.8%,无统计学差异。结论M-FISH法检测灵敏度比尿脱落细胞学高,特异性相似,并可以诊断出所有的高级别浸润性肿瘤。

Objective To evaluate the clinical application of a multiprobe FISH （multicolor fluorescence in situ hybridization,M-FISH） assay in voided urine specimens for detection of bladder cancer and compare the results with those afforded by urinary cytology.Methods Voided urine specimens from 100 cancer patients with or without surgery and 10 patients with prostate hyperplasia were obtained for urinary cytology and FISH.FISH was performed using a mixture of fluorescent labeler DNA probes for the centromeric regions of chromosomes 3,7,and 17 and 9p21 region.Cystoscopy with biopsy or tumor resection was performed in all patients and compared the pathological results with the cytological and FISH findings.Results The sensitivity of M-FISH were 75.6% for low grade tumors,100% for high grade tumors,with overall sensitivity of 85.5%.Urinary cytology affords an overall sensitivity of 62.9%（33.3% for low grade tumors,96.0% for high grade tumors）.Significant difference in overall sensitivity was observed between M-FISH and urinary cytology （P0.05）.The specificity of M-FISH and urinary cytology was 84.6% and 87.8% respectively.No significant difference in specificity was observed between M-FISH and urinary cytology.Conclusion M-FISH improves the sensitivity obtained with urinary cytology for bladder cancer detection with similar specificity,so can detect all high grade infiltrating tumors patients.