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目的:评价荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测膀胱尿路上皮癌患者尿液的应用价值。方法:收集我院2007年10月～2009年4月期间77例膀胱尿路上皮癌患者、43例非尿路上皮癌的血尿患者(通过膀胱镜检查排除尿路上皮癌)和泌尿系良性疾病患者的晨尿,同时行FISH检测和尿脱落细胞学分析,再结合病理结果将两种方法进行比较。FISH检测使用荧光标记DNA探针混合物与细胞核上3、7、17号染色体着丝粒和9p16位点进行杂交。结果:FISH总的敏感度和特异度分别为89.6%和95.3%,G_(1～3)各级的敏感度分别为76.1%、90.9%、100%,Ta、T_(is)、T_1、T_(2～4)各期的敏感度分别为55.6%、100%、88.9%、97.4%。尿脱落细胞学分析总的敏感度和特异度分别为37.7%和93.0%,G_(1～3)各级的敏感度分别为0%、33.3%、78.3%,Ta、T_(is)、T_1、T_(2～4)各期的敏感度分别为11.1%、100%、14.8%、56.4%。结论:FISH比尿脱落细胞学提高了膀胱癌患者检测的敏感度,而特异度两者相近。FISH使低级别浅表型膀胱癌的准确率明显提高,几乎能检测出所有高级别的浸润型膀胱癌。相对于尿脱落细胞学,FISH检测更佳。
Objective: To evaluate the value of fluorescence in situ hybridization (FISH) in the detection of urine in patients with bladder urothelial carcinoma. Methods: Totally 77 patients with bladder urothelial carcinoma from October 2007 to April 2009 in our hospital were enrolled, and 43 patients with hematuria (excluding urothelial carcinoma by cystoscopy) and benign diseases of the urinary tract The morning urine of the patients was analyzed by both FISH and urine cytology. The two methods were compared with the pathological results. The FISH assay uses fluorescently labeled DNA probe mixes to hybridize to chromosomes 3, 7, and 17 centromeres and 9p16 sites on the nucleus. RESULTS: The overall sensitivity and specificity of FISH were 89.6% and 95.3%, respectively. The sensitivities of GISH at all levels were 76.1%, 90.9% and 100%, respectively. The sensitivity of Ta, T_ (is), T_1, T_ The sensitivity of each stage (2-4) was 55.6%, 100%, 88.9% and 97.4% respectively. The sensitivity and specificity of urinary cytology were 37.7% and 93.0%, respectively. The sensitivities of G_ (1-3) were 0%, 33.3%, 78.3% The sensitivities of T_ (2 ~ 4) were 11.1%, 100%, 14.8% and 56.4% respectively. CONCLUSIONS: FISH improves the detection sensitivity of bladder cancer patients compared with exfoliative cytology, while the specificity is similar between the two groups. FISH significantly improved the accuracy of low-grade superficial bladder cancer and detected almost all high-grade invasive bladder cancer. Relative to urinary cytology, FISH better detection.