Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Ines
Kelly
Melanie
The Accuracy of UroVysion FISH Can Improve the Diagnosis of Bladder Cancer
- The 11th most commonly diagnosed cancer worldwide with a significant risk of cancer morbidity and mortality.
- Non-muscle invasive bladder cancer (NMIBC): 75% of patients with BC present with a disease confined to the mucosa (stage Ta and carcinoma in situ) or submucosa (stage T1)
- High risk of recurrence and progression => Need lifelong follow-up after transurethral resection of bladder tumor (TUR)
- Detect gain of chromosome 3, 7, 17 and the deletion of locus 9p21, where P16, the tumor suppressor gene, resides
- Not be influenced by the inflammatory response of the bladder to Bacillus Calmette–Guerin (BCG)
- Potential biomarker for the surveillance of NMIBC patients undergoing intravesical instillation therapies
- At least 25 cells show abnormal. The test is positive if there has been an increase of four or more cells showing multiple chromosomes or more than 12 cells that have lost a 9p21 signal.
All included studies: scored above six based on the Newcastle–Ottawa scale and QUADAS-2 quality assessment result indicated low risk of bias (Figure).
=> A high rating of quality and very low risk of bias.
- Sensitivity of 68% and specificity of 64% in predicting recurrence in patients with NMIBC
=> FISH is a potential biomarker in the prognosis surveillance of NMIBC.
- Cystoscopy: invasive_uncomfortable for patients, expensive, and has the risk of morbidity concomitantly.
- Urine cytology: noninvasive_ voided urine specimens, and useful but its sensitivity for the detection of low-grade tumors is low
- Xpert: voided urine samples after negative cystoscopy and negative abdominal ultrasound (US) and/or negative computed tomography urography (CTU). Quantitate the expression of five mRNA targets (ABL1, CRH, IGF2, UPK1B, and ANXA10) that may be overexpressed in BC. It is an easy-to-use urinary test with improved SN and NPV compared with cytology and UroVysion.
- Hypothesis: Is UroVysion FISH an accurate non-invasive method to detect bladder cancer?
- Keyword: UroVysion bladder cancer, UroVysion Urothelial carcinoma
=> 22 papers including the old research and update papers of some same topics
- The original paper is a meta-analysis research pulished in 2022 and use infomation from other paper up to 2019.
- Discard: before 2019, duplicate, old research of the update papers with same topic, unrelated content
=> Studys included in quantitative and qualiative synthesis: n=7
-Investigate accuracy of UroVysion FISH for a small community
+ 40 patients with BC from April 2018 to July 2018
+ Urothelial carcinoma in 33 cases
+ 1 case of inverted papilloma
+ No malignancy in 6 cases
- Checked by cystoscopy and TURBT
+ Trans Urethral Resection of Bladder Tumor
Results
Nagai et al,
2019
-Primary Tumor Grading
-Tis
-Ta
-T1 or T2
- Outcomes:
+ No significate relationship
+ Higher grade tumors show better with FISH
- Limitations:
+ Sample Size
+ Patient background
Outcomes & Limitations
-See if UroVysion FISH can be used on cultured CTCs
- Circulating tumor cells (CTCs)
+ Tumor cells that responsible for metastasis, by falling off the tumor and washing into the circulatory system
+ Present in blood buy in very low concentrations, makes it hard to use
Kim et al, 2019
- 27 patients, 20 patients had successful culture
Deletion of 9p21 in all but
- 1 Single gain:
+ Of 3, 20 patients
+ Of 7, 14 patients
+ Of 17, 20 patients
- Polysomy, figure 3
+ Of 3 and 7, 9 patients
+ Of 3 and 17, 16 patients
+ Of 7 and 17, 9 patients
Outcomes
- FISH can be used on CTCs
-CTCs maintain chromosomal characteristic of BC cells
-FISH test on CTCs can be done as a noninvasive test
-80% of CTC meet positive criteria of urine specimens, since criteria doesn’t exist
Limitations:
UroVysion not validated for CTCs
Nor for blood specimens
Small sample size
- Comparative study of sensitivity of UroVysion vs urine cytology
-486 BC patients
- 2 consecutive tests in 399
-32 excluded due to no follow up, disagreements, or incoanclusive results
- 116 BC negative
-follow-up average 27 months (1 to 36 months)
- Recurrence rate higher in patients with positive results in both tests, and shorter interval
- Recurrence median was 9 months post 2 (+) tests vs 19 months with 1 (+) test vs 23 months with 2 (-) tests
Outcome
-2 positive UroVysion test can be useful to predict recurrence
- Possibility that postive UroVysion results show presence of invisible precursor lesions in some patients
Limits
- Follow up protocol varied per institution
- Most patients did white light cystoscopy but not photodynamic diagnosis or narrow band imaging examination
- Used UFS (UroVysion Fish Scoring) along with other different categories to determine the biological traits associated with bladder NMIUCs that can progress to MIUCs.
- Assessed the accuracy and effectiveness of the scoring and progression scoring that can indicate MIUCs prior to surgery.
Kocsmar et al, 2020
There were 87 patients enrolled:75 who had confirmed diagnosis of UC (that’s including 57 NMIUC and 12 control group).A few of the patients did not meet the criteria of the study so that’s how it ended up only being 75 patients
- A: UFS I: no genetic abnormality meets the positivity criteria of UroVysion.
- B: UFS II: biallelic deletion of 9p21 and/or ACCN is less than 3.5.
- C & D: UFS III: ACCN is higher than or equal to 3.5 or at least one tumor cell contains six copies (hexasomy) or more of at least one of chromosomes 3, 7, 9, and 17.
- The UFS is effective because 68 of the 75 patients were positive for the progression to MIUC.
- The UFS can be a new diagnostic tool for determining NMIUC progression to MIUC.
- Use pros and cons of UroVysion Fish and compared it to cytology.
- UroVysion FISH has detected 68% of UC/BC while cytology only detected 38%.
- Pros:
+ More accurate than cytology
+ More comfortable for patients than the typical bladder cancer screenings
- Cons:
+ Not very cost effective
+ Time Consuming
Nagai et al, 2021
- Although UroVysion FISH is used as a diagnostic tool for UC, it can also be positive in the nonurothelial cancers.
=> This research is important to inform the appropriate health care professionals of possible misdiagnoses.
A few studies done where UroVysion FISH has been positive:
Reid-Nicholson et al. histological U-FISH detection on the paraffin sections of 31 patients with non-urothelial carcinoma
Kipp et al. histological U-FISH detection by paraffin section and found that the chromosomal abnormalities detected in UC were also common in rare BC histological types
Yang et al. preoperative urinary U-FISH in patients with bladder paraganglioma was positive, showing polyploidy on chromosome 3 and chromosome 17
- Chromosome abberations of 3, 7, 17 and del 9p21: positive U-FISH test for the diagnosis of UC.
- Chromosome aberrations of 7, 8, 10, 16, 17, 18 and X: positive U-FISH test for the diagnosis of Non-UC.
- Certain genes are deleted: positive U-FISH test
- Certain genes on the different common chromosomes (3,7,17): positive U-FISH test
UroVysion Fish is a very accurate diagnostic test for UC and non-UC
This is important to know for healthcare professionals to prevent misdiagnoses and improper unnecessary treatment for patients.
- 204 UC patients with at least 6 months of follow-up
+ Diagnosed with hematuria (n=156)
+ Monitored for tumor recurrence (n=48)
- Voided urine specimens were collected a few days after white light cystoscopy.
- Each patient’s sample was divided into two parts, one for FISH and one for the mRNA test
- After negative cystoscopy and negative abdominal ultrasound (US) and/or computed tomography urography (CTU).
- The sensitivity (SN), specificity (SP), and negative predictive value (NPV) of Xpert BC and UroVysion FISH were calculated and compared with final histology results.
- The overall SN (78 vs. 90%; p = 0.68) of the UroVysion FISH was not significantly higher than that of Xpert test
- The overall SP (93 vs. 85%; p = 0.004) UroVysion FISH had significantly higher than Xpert
+ No difference between the Xpert (AUC = 0.86 and 95% CI 0.80–0.90; p < 0.001) and the FISH test (AUC = 0.85 and 95% CI 0.74–0.97; p < 0.001)
+ Slightly higher diagnostic accuracy (AUC = 0.89 and 95% CI 0.81–0.96; p < 0.001) when combining the Xpert and the FISH test
- Nagai (2019): The standard method for diagnosing BC in Japan is cystoscopy and urine cytology, but invasive and not optimal. UroVysion FISH is one of the reliable urinary markers, but 60% of the cases were not detected. Combination of UroVysion FISH and urine cytology is considered a feasible method for the detection of NMIBC
- Kim (2019): FISH method could be applied to cultured CTCs that maintain the chromosomal characteristics of bladder-cancer cells. Application of FISH to CTCs could be an effective first step to confirm that cultured CTCs originated from primary BC before clinical application.
- Ikeda (2020): In Japan, a prospective comparative study showed that the UroVysion test provided higher sensitivity than urine cytology in detecting BC during follow-up after TURBT but its false-positive rate is still high. Yet, the positive rates of urinary cytology were relatively low in terms of recurrence without CIS. Therefore, the two consecutive UroVysion tests are considered to be useful tools for predicting this type of recurrence.
- Kocsmar (2020): UroVysion Fish assesses aneusomy in bladder cancer and can provide strong prognostic information from the voided urine even prior to tumor resection, including the indication of a probable muscle invasion
- Nagai (2021): The accuracy of UroVysion tests can improve the diagnosis of UCs, has the potential to detect genetic mutations in cells from urine samplesand expect to provide new diagnostic tools in the treatment of UC
- Ke (2022): a positive UroVysionTM result is not specific to UC but bladder, prostatic cancer. This is because they invades into the urethra, and tumors metastatic to the bladder are occasionally the cause of a positive urine FISH result. Therefore, history and imaging information should be combined when interpreting FISH results.
- Kavcic (2022): U-Fish is good for detect BC but better if use with Xpert"
- Overally, UroVysion FISH is an accurate non-invasive method can be used to detect Bladder Cancer because at the current years it has high Sensitivity and Specificity level up to 100% with p<0.05
Ikeda, Atsushi, et al. “Risk for Intravesical Recurrence of Bladder Cancer Stratified by the Results on Two Consecutive UroVysion Fluorescence in Situ Hybridization Tests: A Prospective Follow-up Study in Japan.” International Journal of Clinical Oncology, vol. 25, no. 6, 2020, pp. 1163–1169., https://doi.org/10.1007/s10147-020-01634-9.
Kavcic, Niko, et al. “Clinical Evaluation of Two Non-Invasive Genetic Tests for Detection and Monitoring of Urothelial Carcinoma: Validation of UroVysion and Xpert Bladder Cancer Detection Test.” Frontiers in Genetics, vol. 13, 2022, https://doi.org/10.3389/fgene.2022.839598.
Ke, Chunjin, et al. “UROVYSIONTM Fluorescence in Situ Hybridization in Urological Cancers: A Narrative Review and Future Perspectives.” Cancers, vol. 14, no. 21, 2022, p. 5423., https://doi.org/10.3390/cancers14215423.
Kim, Tae-Jung, et al. “Urovysion Fish Could Be Effective and Useful Method to Confirm the Identity of Cultured Circulating Tumor Cells from Bladder Cancer Patients.” Journal of Cancer, vol. 10, no. 14, 2019, pp. 3259–3266., https://doi.org/10.7150/jca.30079.
Kocsmár, Ildikó, et al. “Development and Initial Testing of a Modified Urovysion-Based Fluorescence in Situ Hybridization Score for Prediction of Progression in Bladder Cancer.” American Journal of Clinical Pathology, vol. 153, no. 2, 2020, pp. 274–284., https://doi.org/10.1093/ajcp/aqz165.
Nagai, Takashi, et al. “Examination of Diagnostic Accuracy of UroVysion Fluorescence in Situ Hybridization for Bladder Cancer in a Single Community of Japanese Hospital Patients.” Asian Pacific Journal of Cancer Prevention, vol. 20, no. 4, 2019, pp. 1271–1273., https://doi.org/10.31557/apjcp.2019.20.4.1271.
Nagai, Takashi, et al. “UroVysion Fluorescence in Situ Hybridization in Urothelial Carcinoma: A Narrative Review and Future Perspectives.” Translational Andrology and Urology, vol. 10, no. 4, 2021, pp. 1908–1917., https://doi.org/10.21037/tau-20-1207.