Cytologic Detection of Urothelial Lesions: 2 (Essentials in Cytopathology)
Based on the tumor size, there were 83 patients with tumors 1 cm or less, 23 with 3 cm or less and 16 with tumors more than 3 cm.
The tumor characteristics of our population may have resulted in the FISH and cytology sensitivity being lower than that of other studies. According to the study of Bhuiyan et al. Urine specimens were exclusively collected from voided urine in this study. All participants in this study were cases under surveillance for BUC in the clinical practice setting. According to several prior reports, a variety of criteria has been applied for FISH positive results, nevertheless, the optimal criteria to define FISH-positive results are not absolutely clear 7 , 8 , 18 , In some investigations, a specimen was considered FISH positive for BC if ten or more cells with gain of a single chromosome or if ten or more cells with homozygous loss of the 9p21 locus 18 , In this study, fifteen patients with false-negative FISH had at least one cell with an abnormal signal pattern consistent with polysomy of chromosome 3, 7, 17, and 9p We regard our criteria for FISH positive results as more strict than those of previous studies.
Among 59 patients who had had a history of BUC with or without upper tract UC, 19 underwent intravesical immunotherapy. Because intravesical therapy might cause false-positive result of urine test for detecting BUC 20 and chromosomal integrity was not affected by intravesical therapy 21 , 22 , it is not likely that intravesical therapy affected FISH result to show lower sensitivity of FISH than other study.
Among 36 patients who had suspicious lesions without visible tumor on cystoscopy, 15 were FISH-positive with discordant results atypical or negative on cytology. Thirteen In these patients, seven patients without visible tumor on cystoscopy were atypical or negative in cytology and 6 of them had the positive results of FISH.
Cytologic Detection of Urothelial Lesions essential in cytopathology vol 2
However, none of the patients with negative results of FISH had the results suggestive of malignancy or positive in cytology. The majority of them 51 were negative or atypical on cytology, while only three had results suggestive of malignancy or positive by cytology. Overall, 49 There were 18 false-positive results by FISH. Among them, four patients had results suggestive of malignancy or positive by cytology; TUR or biopsy was performed in two patients with abnormal lesions on cystoscopy.
The histopathology of these cases was chronic inflammation and reactive urothelium without malignancy. According to the report of Sarosdy et al. Another investigation reported that multi-target FISH might help to stratify the risk of UC recurrence, at the time of a negative cystoscopy, by using optimal criteria for FISH positive results 8.
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Although two patients with false-positive FISH had BUC diagnosed during follow-up, it is hard to assess the clinical implication of the false-positive FISH results because of the limited follow-up duration of this study. The limitations of this study include that it was a retrospective study and that the histopathology results were not available in all patients because TUR or biopsy was determined by cystoscopy finding. However, cystoscopy, considered as the gold standard for the detection of BUC, was performed to identify the presence or absence of bladder lesions in all patients. Moreover, to exclude the influence of upper tract UC on the analysis, the study population was restricted to only patients being evaluated for BUC.
Despite these limitations, this study is one of few studies that compared the performance characteristics of FISH and cytology in clinical practice setting, unlike other studies which included normal healthy volunteers and the patients with BPH as controls. In conclusion, the sensitivity of the FISH assay using chromosomes 3, 7, 17, and 9p21 for the detection of BUC was superior to that of urine cytology, regardless of the tumor stage and grade, although FISH was slightly less specific than cytology.
Even if taking its high cost into consideration, FISH may be a significant additional and complementary method for the detection of BUC, especially in patients who have no visible tumor but flat, erythematous mucosa suspicious lesion on cystoscopy. J Korean Med Sci. Published online Nov 09, Address for correspondence: Hyun Moo Lee, M. Go to:. Patients and samples Voided urine specimens from patients were obtained for FISH analysis and cytology examination between April and July Cytology Cytology samples were centrifuged 1, rpm for 5 min and stained using Papanicolaou's technique.
Histopathology examination Pathologists performed the histopathology evaluation on the patients who underwent TUR or biopsy. Statistical analysis The sensitivity of FISH and cytology was determined for the patients with pathology-proven UC, stratified for tumor stage and grade. Biology and management of bladder cancer. N Engl J Med ;— The clinical value of urinary cytology: 12 years of experience with patients.
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J Mol Diagn ;— Multi-target fluorescence in situ hybridization in bladder washings for prediction of recurrent bladder cancer. Int J Cancer ;— Molecular detection of primary bladder cancer by microsatellite analysis. Science ;— A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. Clinical utility of a multiprobe FISH assay in voided urine specimens for the detection of bladder cancer and its recurrences, compared with urinary cytology. Eur Urol ;— Utility of a multiprobe fluorescence in situ hybridization assay in the detection of superficial urothelial bladder cancer.
Cancer Genet Cytogenet ;— A comparison of BTA stat, hemoglobin dipstick, telomerase and Vysis UroVysion assays for the detection of urothelial carcinoma in urine. Clinical evaluation of a multitarget fluorescent in situ hybridization assay for detection of bladder cancer. Sensitivity of human complement factor H related protein BTA stat test and voided urine cytology in the diagnosis of bladder cancer.
Four bladder tumor markers have a disappointingly low sensitivity for small size and low grade recurrence. Performance characteristics of multiple urinary tumor markers and sample collection techniques in the detection of transitional cell carcinoma of the bladder. Clin Chim Acta ;— Multiprobe FISH for enhanced detection of bladder cancer in voided urine specimens and bladder washings. Am J Clin Pathol ;— Multicolor fluorescence in situ hybridization M-FISH on cells from urine for the detection of bladder cancer.
Cytogenet Genome Res ;— Does topical instillation therapy influence chromosomal aberrations in superficial bladder cancer? Comparison of multitarget fluorescence in situ hybridization in urine with other noninvasive tests for detecting bladder cancer. BJU Int ;— MeSH Terms. Middle Aged. Reproducibility of Results.
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Please follow the detailed Help center instructions to transfer the files to supported eReaders. Continue the series. See more. Pancreatic Cytopathology. David C. Diagnosis by cytologic means is what the mathematicians would describe as elegant; the methods are often simple but richly nuanced, while the results can be profound though succinctly stated. Tiny samples atraumatically obtained are at the heart of both the elegance and the dif? Following initial successes of traditional exfoliative cytology, further applications were long constrained by the fact that few body surfaces present themselves for direct collection of exfo- ated cells.
Thus, it was inevitable that advances in nonoperative evaluations for speci? Hence the proliferation of sampling methods with techniques the same as their names, including brushing, washing, lavage, and aspiration. Examples come readily to mind. One of the most dramatic bursts in cytodiagnosis happened in the s, when deep-lung sampling by bronchoalveolar lavage BAL arrived at about the same time as the AIDS pandemic.
Frequent and often repeated diagnosis of CMV and pneumocystis quickly led to numerous such samples being submitted to many laboratories. These now common infectious agents and this new technique were highly suited to rapid evaluation of AIDS patients. The rapid rise of? Although not really new, the explosion in its use had awaited both cli- cal acceptance and adequate training for a critical mass of pathologists.
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Syed Z. This volume, part of the Essentials in Cytopathology book series, fits into the lab coat pocket and is ideal for portability and quick reference. Each volume in the series is heavily illustrated with a full color art program, while the text follows a user-friendly outline format.
Pathology Outlines - Paris system for urothelial neoplasia
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