尿脱落上皮细胞荧光原位杂交技术在尿路上皮癌诊断中价值  

Value of fluorescence in situ hybridization assay in urine exfoliative cells to the diagnosis of urothelial carcinoma

作　　者：史炯[1] 孟凡青[1] 濮晓红 叶庆[1] 

机构地区：[1]南京鼓楼医院病理科,南京210008

出　　处：《中华实用诊断与治疗杂志》2015年第11期1128-1130,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：南京市卫生局青年人才培养计划第三层次(2012-3-300)

摘　　要：目的应用荧光原位杂交技术(FISH)检测尿脱落上皮细胞遗传学改变,探讨其在尿路上皮癌诊断中的价值。方法 279例患者分为血尿患者139例,尿路占位患者64例,尿路上皮癌术后患者57例和其他泌尿系统疾病患者19例,均应用FISH技术检测尿脱落上皮细胞3、7、17号染色体着丝粒和9p21位点遗传学改变,与膀胱镜活检或手术组织病理结果进行对照,计算并比较FISH技术在不同组间诊断尿路上皮癌的敏感度和特异度。结果膀胱镜活检或手术组织病理确诊恶性肿瘤64例,其中尿路上皮癌56例,肾细胞癌5例,肾脏转移性恶性肿瘤2例,发现异型细胞1例;215例膀胱镜活检组织病理未查见恶性细胞。FISH技术诊断阳性76例,阴性203例,其中假阳性29例,假阴性9例,诊断尿路上皮癌的敏感度为83.93%(47/56),特异度为87.00%(194/223);对尿路上皮癌术后、尿路占位、血尿及其他泌尿系统疾病患者,FISH技术诊断尿路上皮癌的敏感度分别为100%(9/9)、82.35%(28/34)、81.82%(9/11)和50%(1/2);特异度分别为83.33%(40/48)、86.67%(26/30)、89.06%(114/128)和82.35%(14/17)。结论对于血尿或尿路上皮癌术后的患者应用尿脱落上皮细胞FISH技术诊断具有较高的敏感度和特异度,尤其适用于尿路上皮癌术后复发的患者。Objective To explore the value of fluorescence in situ hybridization （FISH） to the diagnosis of urothelial carcinoma by detecting the cytogenetic changes of urine exfoliative cells by FISH. Methods A total of 279 patients including 139 patients with hematuria, 64 patients with urinary tract occupying lesions, 57 patients after operation for urothelial carcinoma and 19 patients with other urinary tract diseases were detected the cytogenetic changes of chromosome centromere 3, 7 and 17, as well as 9p21 in urine exfoliative cells by FISH, and compared with the cystoscopy biopsy and hisotopathological results. The sensitivity and specificity of FISH for diagnosing urothelial carcinoma were calculated and compared among four groups. Results The cystoscopy biopsy and hisotopathological results confirmed malignant tumor in 64 patients including urothelial carcinoma in 56, renal cell cancer in 5, renal metastatic cancer in 2 and tumor cell in 1. The other 215 patients were not found malignant tumors. The positive, negative, false-positive and false-negative results were found in 76, 203, 29 and 9 patients respectively. The sensitivity and specificity of FISH for urothelial carcinoma were 83. 93% （47/56） and 87. 00% （194/223）, respectively. The sensitivities of FISH were 100% （9/9）, 82.35% （28/34）, 81.82% （9/11） and 50% （1/2）, and the speeificities were 83.83% （40/48）, 86.67% （26/80）, 89.06%（114/128） and 82.35% （14/17） for those after operation for urothelial carcinoma, urinary tract occupying lesions, hematuria and other urinary tract diseases. Conclusion Detection of the cytogenetic changes of urine exfoliative ceils by FISH has high sensitivity and specificity for the patients with hematuria or after operation for urothelial carcinoma, especially for surveillance of recurrence of urothelial carcinoma.

关 键 词：尿路上皮癌 荧光原位杂交技术 尿脱落上皮细胞 

分 类 号：R737.1[医药卫生—肿瘤]