Indian Journal of Urology Users online:2328  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
UROSCAN
Year : 2012  |  Volume : 28  |  Issue : 3  |  Page : 370-371
 

Is fluorescence in situ hybridization useful for prediction of residual tumor after transurethral resection of bladder tumor?


,

Date of Web Publication19-Oct-2012

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

 

How to cite this article:
Mandal S. Is fluorescence in situ hybridization useful for prediction of residual tumor after transurethral resection of bladder tumor?. Indian J Urol 2012;28:370-1

How to cite this URL:
Mandal S. Is fluorescence in situ hybridization useful for prediction of residual tumor after transurethral resection of bladder tumor?. Indian J Urol [serial online] 2012 [cited 2019 Oct 21];28:370-1. Available from: http://www.indianjurol.com/text.asp?2012/28/3/370/102735

Ding T, Wang Y, Cao Y, Yang L. Clinical utility of fluorescence in situ hybridization for prediction of residual tumor after transurethral resection of bladder urothelial carcinoma. Urology 2011;77:855-60.



   Summary Top


Fluorescence in situ hybridization (FISH) analysis for aneuploidy of chromosomes 3, 7, and 17 and loss of the 9p21 have proved to be highly sensitive and specific when compared with urine cytology in the detection of bladder cancer. [1] However, the authors in this study have tried to assess the utility of FISH as a predictor for detection of residual tumor after transurethral resection of bladder tumor (TURBT).

Bladder tumor resection was performed by a single experienced surgeon in 125 patients and bladder reviewed using both 12° and 70° lenses to ensure complete resection. Thirty-four patients were found to have chronic cystitis and urothelial hyperplasia on histopathology (HPE) and no tumor was identified and therefore were excluded from the study. Two patients refused to undergo repeat TURBT and were also excluded. The remaining 89 patients underwent repeat TURBT (for Ta or T1 tumors; n = 82) or radical cystectomy (for T2 tumors; n = 7) after 4-6 weeks. Voided urine samples (50-300 mL) were collected just before the first TURBT and 4-6 weeks after the first TURBT but before the repeat TURBT. The cells from the voided urine samples were analyzed with FISH probes to detect presence of aneuploidy.

Repeat TURBT revealed residual disease in 38 (42.7%) patients. The positive percentages of urinary FISH results in the patients with and without residual tumor before and after the initial TURBT were compared. Before the first TURBT, no significant differences were seen in the FISH-positive percentage between those with and without residual tumor (71.1% vs. 76.5%). After the first TURBT, the FISH-positive percentage in those with residual tumor was significantly greater than in those without residual tumor (42.2% vs. 17.6%). Moreover, before and after the initial TURBT, the percentage of conversion from FISH-positive to FISH-negative status in those with residual tumor was significantly lower than that in those without residual tumor (28.9% vs. 58.9%). No patients were observed with conversion of the FISH results from negative to positive in those with and without residual tumor after initial TURBT. The positive and negative predictive value of FISH for residual tumor were 64.0% and 65.6%, respectively. Thus, some limitations are still present in the use of FISH in predicting residual bladder tumor after TURBT.


   Comments Top


TURBT is the standard treatment for bladder tumor but its efficiency has been lower than expected. The percentage of positive histologic findings at repeat TURBT has been reported to be 6%-78%. [2] This rate increased with the extent of tumor infiltration noted on the initial TURBT. It was 33%-78% after the resection of stage T1 tumors and was only 6% after resection of stage Ta tumors. Again, Schwabold et al [3] reported that only 14% of the malignant tissue was at other locations outside the initial tumor resection area. The presence of residual disease after the initial TURBT increases the risk of early tumor recurrence and progression and patients without residual disease or recurrence had a better prognosis. Therefore, repeat TURBT routinely in all cases of non-muscle-invasive bladder cancer has been suggested. [4] However, the role of repeat TURBT is still controversial because of the treatment costs, morbidity, and delay in adjuvant topical therapy. Therefore, a tumor marker that would early show which patients will require another intervention would not only decrease the number of unnecessary procedures but also might reveal those with high-risk disease. The FDA-approved UroVysion FISH assay on urine cells to detect chromosomal aberrations associated with bladder cancer. [5] In addition, it has been suggested that this test might be useful for the detection of tumor recurrence before it is visible by cystoscopy. [1] The preliminary results of this study suggest that urinary FISH assay, in addition to being a good diagnostic marker of bladder UC, could also be used as a predictor of residual disease after TURBT. FISH assay can be valuable for the prediction of the residual tumor load after the initial TURBT. The residual tumor, which could be the source of recurrence or progression, could potentially be identified and resected earlier, thus decreasing the risk of early tumor recurrence and progression. FISH should not be incorporated into rigid schemes of clinical decision making for predicting residual tumor after TURBT, and everyone should be aware of its restrictions. Additional prospective and multicenter trials with larger sample sizes are needed to confirm the results of this study.

 
   References Top

1.May M, Hakenberg OW, Gunia S, Pohling P, Helke C, Lübbe L, et al. Comparative diagnostic value of urine cytology, UBC-ELISA, and fluorescence in situ hybridization for detection of transitional cell carcinoma of urinary bladder in routine clinical practice. Urology 2007; 7 0:449-53.  Back to cited text no. 1
    
2.Herr HW, Donat SM, Dalbagni G. Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy? J Urol 2007;177:75-9.  Back to cited text no. 2
[PUBMED]    
3.Schwaibold HE, Sivalingam S, May F, Hartung R. The value of a second transurethral resection for T1 bladder cancer. BJU Int 2006;97:1199-201.  Back to cited text no. 3
[PUBMED]    
4.Divrik RT, Sahin AF, Yildirim U, Altok M, Zorlu F. Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: A prospective randomised clinical trial. Eur Urol. 2010;58:185-190.  Back to cited text no. 4
[PUBMED]    
5.Halling KC, King W, Sokolova IA, Meyer RG, Burkhardt HM, Halling AC, et al. A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. J Urol 2000;164:1768-75.  Back to cited text no. 5
[PUBMED]    




 

Top
Print this article  Email this article
 

    

 
   Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (208 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Summary
   Comments
    References

 Article Access Statistics
    Viewed798    
    Printed34    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal

HEALTHWARE INDIA