EAU 2005 - ABST[628] VOIDED URINARY SPECIMEN-COMPARISON OF A MULTITARGET IN SITU HYBRIDISATION FLUORESCENCE (FISH) ASSAY, NMP22-BLADDERCHEK© AND CONVENTIONAL CYTOLOGY FOR DETECTION OF TRANSITIONAL CELL CANCER OF THE BLADDER

Akkad T.¹, Verdorfer I.², Mueller T.¹, Gozzi C.¹, Bartsch G.¹, Steiner H.¹

¹Medical University Innsbruck, Urology, Innsbruck, Austria, ²Medical University Innsbruck, Pathology, Innsbruck, Austria

INTRODUCTION & OBJECTIVES: To evaluate the multitarget fluorescence in situ hybridisation (FISH) assay Urovysion© (Vysis, Inc., Downers Grove, Illinois) and NMP22-BladderChek© (Matritech Inc., Newton, MA, USA) for detection of TCC of the bladder from voided urinary specimen and comparison to standard cytology.

MATERIAL & METHODS: Voided urine samples from 90 patients were obtained for urine cytology, FISH analyzes and NMP22-BladderChek©. The collective included 60 patients with suspected bladder cancer or a history of bladder cancer that were in regular follow-up. In case of suspicious findings, patients underwent TURB or bladder biopsy. 30 healthy patients served as controls.

RESULTS: Results of sensitivities are shown in Table 1. For low grade TCC (G1), FISH had a three times higher sensitivity than either NMP22-BladderChek© or Cytology. For high grade TCC (G3), FISH and cytology had higher sensitivities than NMP22-BladderChek©. Specificity in the control group for FISH, NMP22-BladderChek© and cytology was 100%, 90% and 88%, respectively. All tests had lower specificity in patients with a history of bladder cancer (Specificity: FISH=45%; NMP22=70%; Cytology=75%).

In 14 urinary samples (15,5%), FISH signals could not be sufficiently counted due to inadequate cell numbers in the probes. The same problem applied to 9 (10%) urinary samples for cytology. One NMP22-BladderChek© (1.1%) was classified as invalid.

CONCLUSIONS: In this series, FISH was the best method to detect bladder cancer in voided urine specimen. In particular, FISH was superior for detection of low grade TCC. Still, about 50% of the low grade tumours would be missed without cystoscopy. The specificity of FISH in patients with a history of bladder cancer seems to be too low. However, false positive FISH might reflect sub clinical recurrence and therefore positive FISH might be of prognostic value. Further follow-up of those patients will help to interpret these results.

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