Long Term Follow-Up of Efficacy of Multicolor Fluorescence In Situ Hybridization (UroVysion) in Detecting Non-Muscle-Invasive Urothelial Neoplasias
Bing Leng, Sheila M Dobin, Kimberly Walker, Arundhati Rao. Scott & White Healthcare, Temple, TX
Background: Urothelial carcinoma (UC) is associated with a significant high risk of recurrence and progression, and patients with UC require long-term surveillance. The UroVysion multicolor fluorescence in situ hybridization has been shown to have higher sensitivity and specificity for detecting UC compared to traditional urine cytology study. But there are few long term follow-up studies to compare the efficiency of UroVysion, urine cytology, and cystoscopy in detecting non-muscle-invasive urothelial neoplasias (NMIUNs). We present a study of 79 patients with a minimum follow-up of 5 years.
Design: Data from 612 patient encounters for bladder tumor follow-up in Scott and White Memorial Hospital from 2005 were retrieved. Specimens were considered UroVision positive if there were 4 or more cells with polysomy on at least 2 chromosomes (3,7, or 17) and /or 12 cells with no signal for chromosome 9p21. UroVysion results were correlated with urine cytology, cystoscopy, and concurrent biopsy diagnosis.
Results: 121 encounters were found to have UroVysion, cytology, cystoscopy, and concurrent biopsy results. Among these, 63 cases were diagnosed negative, 23 low grade non-muscle-invasive UC, 13 high grade non-muscle-invasive UC, 12 carcinoma in situ (CIS), 5 urothelial neoplasms of low malignant potential, and 5 high grade muscle-invasive UC. The sensitivity and specificity of UroVysion to detect NMIUNs were 68% and 60%; those of cytology were 28% (p<0.05) and 89%; those of cystoscopy were 49% (p<0.05) and 73%. Combining cytology and cystoscopy had 60% sensitivity (p>0.05) and 65% specificity. Using polysomy criterion alone to detect NMIUNs yielded a sensitivity of 66% (p>0.05) and specificity of 70%. Using loss of both copies of 9p21 alone gave a sensitivity of 42% (p<0.05) and specificity of 76%. The sensitivities of UroVysion to detect CIS, low grade non-muscle-invasive UC, and high grade non-muscle-invasive UC were 92%, 61%, and 77% respectively; those of cytology were 50%, 9%, and 54% respectively; those of cystoscopy were 42%, 48%, and 54% respectively. Six patients with positive UroVysion, but negative cytology, developed NMIUNs in the two years' follow-up.
Conclusions: UroVysion is a very efficient screening method for NMIUNs with extremely high sensitivity to detect CIS. Adding loss of both copies of 9p21 does not further increase the sensitivity and specificity to detect NMIUNs compared to polysomy alone.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 184, Monday Afternoon