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[376] Correlation of Upper Urinary Track Routine Cytology (RC) and Fluorescence In Situ Hybridization (FISH) Findings with Biopsy Results Including FISH

DM Vlasoff, JS Voss, BR Kipp, KC Halling, TJ Sebo. Mayo Clinic, Rochester, MN

Background: The ability to establish pathology in the upper urinary track (UUT) including ureter and renal pelvis is challenging due to limitations in direct visualization of the region of concern. Compounding the problem is the difficulty in interpreting RC from urine samples collected from this location. The utility of FISH is well-established for determining bladder pathology from cells collected from urine. The purpose of this study was to determine the potential role FISH may play in UUT pathology.
Design: 8 cases from 7 patients were evaluated in which the following information was established: Results from RC, FISH cytology (FC), follow-up biopsy (bx), and FISH on bx (FB). The FISH UroVysion probe set was used on both urine and follow-up bx material, and specimens were considered positive by FISH if 5 cells demonstrated gains of two or more signals (polysomy) or if 20% of cells demonstrated homozygous 9p21 deletion.
Results: There were 7 males and 1 females. The mean age was 71 years (range 51-87). There were 5 from the left ureter, 1 from the right ureter, 1 from the right renal pelvis, and 1 from the left renal pelvis. RC was negative (4), positive (2), or suspicious (2). FC was negative (1; <5 polysomic cells), equivocal (1; 5 polysomic cells), or positive (6; 10 or more polysomic cells). Follow-up bx was negative (2) and positive (6). Of the positive bxes, all were grade 3 (of 3) urothelial carcinomas (1 Ta, 2 Tis, and 3 T1). Of the 4 negative cytology cases, FC correctly established the follow-up bx diagnosis in all cases (2 negative, 2 positive) with complete correlation with FB result. Of the 2 suspicious cytology cases, FC was positive for both with positive follow-up bx and FB results.
Conclusions: FISH using UUT urine specimens may be useful in correctly identifying patients with significant pathology when RC is either negative or equivocal (suspicious). Cut points used for classifying FC in the UUT samples seem appropriate.
Category: Cytopathology

Tuesday, March 27, 2007

Poster # 27, Tuesday Afternoon