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目的探讨荧光原位杂交技术(FISH)在上尿路尿路上皮癌(UC-UT)诊断中的应用价值。方法收集20名健康人尿液行FISH检查且建立阈值,再留取65名疑为UC-UT患者和55名上尿路结石患者尿液行FISH和尿脱落细胞检查。以病理结果为标准,比较这两种检查方法的准确性。结果65例疑为UC-UT患者中58例病理确诊为UC-UT。FISH检测UC-UT总敏感性84.48%,与尿脱落细胞学检查的39.66%相比,差异有统计学意义(P=0.000);而特异性相仿,分别是92.72%和98.18%(P=0.363)。FISH和尿脱落细胞学检查对低级别尿路上皮癌敏感性分别是63.64%和22.73%,对高级别尿路癌的敏感性分别是97.22%和50.00%,分别P=0.006和P=0.000;对非肌层浸润性癌敏感性分别是63.64%和27.27%,对肌层浸润性癌敏感性分别是89.36%和42.55%,分别P=0.087和P=0.000。结论 FISH检查具有较好的敏感性和特异性,可用于UC-UT早期诊断,对高分级、高分期的UC-UT的诊断价值更高。
Objective To investigate the value of fluorescence in situ hybridization (FISH) in the diagnosis of upper urinary tract urothelial carcinoma (UC-UT). Methods Twenty urine samples from healthy volunteers were collected and FISH and urinary cytology were performed to establish the threshold value. Urine specimens from 65 patients with suspected UC-UT and 55 patients with upper urinary tract stones were collected. The pathological results as a criterion to compare the accuracy of these two methods of inspection. RESULTS: Of the 65 suspected UC-UT patients, 58 were pathologically diagnosed as UC-UT. The total sensitivity of UC-UT was 84.48% with FISH and 39.66% with urine cytology (P = 0.000). The specificity was 92.72% and 98.18% respectively (P = 0.363 ). The sensitivity of FISH and urine cytology to low-grade urothelial carcinoma were 63.64% and 22.73%, respectively, and the sensitivity to high-grade urothelial carcinoma was 97.22% and 50.00%, respectively, P = 0.006 and P = 0.000; The sensitivity to non-myometrial invasive carcinoma was 63.64% and 27.27%, respectively. The sensitivity to myometrial invasive cancer was 89.36% and 42.55%, respectively, P = 0.087 and P = 0.000, respectively. Conclusion FISH has good sensitivity and specificity, which can be used for the early diagnosis of UC-UT. It is more valuable for the diagnosis of high grade and high stage UC-UT.