盐酸吡柔比星荧光膀胱镜对非肌层浸润性膀胱癌的诊断价值

目的:评估以盐酸吡柔比星作为荧光剂的荧光膀胱镜检查对非肌层浸润性膀胱癌的诊断价值。方法:本次研究共63例患者,膀胱灌注盐酸吡柔比星溶液40 mg,保留30 min后排空置入膀胱镜,分别在普通白光及荧光下观察,对白光和/或荧光下显示阳性或可疑区域进行活检,同时行电切术。结果:63例患者中,18例患者普通白光膀胱镜及荧光膀胱镜检查均阴性;其余45例患者共取活检92处,平均每例患者取活检2.04处。其中53处病理报告为尿路上皮癌,荧光膀胱镜敏感性为90.57%（48/53）,特异性为64.10%（25/39）;普通白光膀胱镜敏感性为71.70%（38/53）,特异性为56.41%（22/39）。结论:吡柔比星荧光膀胱镜诊断非肌层浸润性膀胱癌的敏感性和特异性均显著高于普通白光膀胱镜,具有较高的临床应用价值。     

THP定位诊断早期非肌层浸润性膀胱癌

目的:研究THP(吡柔比星)对非肌层浸润性膀胱癌早期的定位诊断效果。方法:选择35例已诊断膀胱癌或高度怀疑尿路上皮癌患者。病人术前及术后复查时,30mgTHP溶入50ml 5%葡萄糖液中,灌入已排空的膀胱中,保留15分钟,排出THP,彻底冲洗膀胱。普通膀胱镜检查,有THP吸收的非肿瘤区域取活检,无THP吸收的部位随机活检。结果:35例患者中存在非肌层浸润性膀胱癌早期的共6例。结论:THP对非肌层浸润性膀胱癌早期的定位诊断效果明确,安全性好。     

吡柔比星膀胱内灌注预防非肌层浸润性膀胱尿路上皮癌复发的机制

目的 观察膀胱内灌注吡柔比星后对正常膀胱组织和膀胱癌组织细胞凋亡的影响,探讨吡柔比星膀胱内灌注预防非肌层浸润性膀胱尿路上皮癌复发的机制.方法 将40例非肌层浸润性膀胱尿路上皮癌患者随机分为3组,15例于经尿道膀胱肿瘤电切术(TUR-BT)前1h、15例于TUR-BT术前24 h行膀胱内灌注(30 mg吡柔比星,在膀胱内保留30 min),对照组10例仅行TUR-BT术.取患者的正常膀胱组织和膀胱癌组织,以荧光显微镜观察吡柔比星的分布,原位末端标记(TUNEL)法检测细胞凋亡,免疫组化染色检测bcl-2和bax的蛋白表达.结果 吡柔比星膀胱内灌注后1h,正常膀胱组织黏膜层偶见吡柔比星荧光,膀胱癌组织可见弥漫分布的吡柔比星荧光,可达肌层.24 h后,在膀胱癌组织内仍可见到吡柔比星的荧光.TUNEL检测结果显示,实验组膀胱癌的凋亡指数显著高于对照组(P<0.01).bcl-2/bax比值与凋亡指数具有相关性.结论 吡柔比星灌注化疗中可选择性作用于非肌层浸润性膀胱尿路上皮癌.通过影响膀胱癌组织bcl-2/bax表达,诱导肿瘤细胞发生凋亡,可能是吡柔比星膀胱内灌注预防非肌层浸润性膀胱尿路上皮癌复发的重要机制.     

沉默信息调节因子1在膀胱尿路上皮细胞癌中的表达与意义

目的:检测沉默信息调节因子1(SIRT1)在膀胱尿路上皮癌(BUC)中的表达,并探讨其与临床病理指标的相关性。方法:选取经临床病理诊断的BUC标本72例,其中低级别尿路上皮癌42例,高级别尿路上皮癌30例;阴性对照组为正常膀胱组织19例(膀胱镜检术或膀胱切开取石术中随机取活检时取得)。应用免疫组化方法(二步法)检测SIRT1分别在低级别与高级别BUC中的表达与分布,分析其与肿瘤的分期和病理分级的关系。结果:SIRT1在正常膀胱组织和膀胱癌组织中均有表达,正常膀胱组织中阳性表达率为31.58%(6/19),而在BUC组中,阳性表达率为77.78%(56/72),明显高于正常膀胱组织(P<0.05);并且随着肿瘤分期和癌理分级的升高SIRT1蛋白的表达增加,其中低级别膀胱癌阳性表达率为69.05%(29/42),高级别膀胱癌阳性表达率为90.00%(27/30),两者间的差异具有统计学意义(P<0.05)。结论:SIRT1在BUC中高表达,可能与BUC的发生、病理分级和临床分期有关,并有可能作为判断BUC侵袭力、监测复发的肿瘤标志物。阻断SIRT1表达有望成为膀胱癌靶向治疗的新靶点。     

中国人尿路斑块蛋白Ib组织特异性及其启动子的克隆与鉴定

目的:研究中国人尿路斑块蛋白Ib的组织特异性并克隆与鉴定其启动子。方法:RT-PCR检测32例膀胱癌、16例正常膀胱粘膜、15例正常小肠粘膜、16例正常食道粘膜、19例正常肾实质、20例正常肝实质、8例正常皮肤及8例正常心肌标本中尿路斑块蛋白Ib的表达。以人正常膀胱粘膜为材料提取基因组DNA,克隆尿路斑块蛋白Ib启动子片段,并凝胶电泳和测序鉴定。结果:所有正常膀胱粘膜标本、16例分化Ⅰ级膀胱癌中有15例(93.8%)、9例分化Ⅱ级膀胱癌中有7例(77.8%)、7例分化Ⅲ级膀胱癌中有4例(57.1%)检测到尿路斑块蛋白Ib表达,而正常食道粘膜、小肠粘膜、肾实质、肝实质、皮肤、心肌标本均未检测到尿路斑块蛋白Ib表达。中国人尿路斑块蛋白Ib234bp的启动子被克隆并完成鉴定。结论:中国人尿路斑块蛋白Ib具有高度尿路移行上皮特异性,加上其启动子短小,尿路斑块蛋白Ib启动子非常适合膀胱癌的靶向基因治疗研究。我们成功克隆出中国人尿路斑块蛋白Ib启动子片段,为后续研究奠定了基础。     

窄带成像联合自荧光支气管镜在肺癌诊断中的价值

背景与目的窄带成像(narrow-band imaging,NBI)与自荧光成像(autofluorescence imaging,AFI)是近几年临床诊断肺癌的支气管镜新技术。本研究旨在研究这两种技术的结合是否能提高肺癌诊断的敏感性和特异性。方法该项目共纳入137例疑似肺癌患者,所有患者的检查均基于Olympus Evis Lucera电子支气管镜系统,依次进行白光支气管镜(white light bronchoscopy,WLB)、窄带成像、自荧光成像检查,在每位患者镜下异常部位至少取3块组织送检。结果 WLB的敏感性、特异性分别为56.6%和62.5%;NBI成像的敏感性、特异性分别为71.3%和75.0%;AFI敏感性、特异性分别为82.2%和25.0%;NBI联合AFI的敏感性、特异性分别为94.6%和87.5%。NBI+AFI与AFI相比,两者敏感性及特异性均有统计学差异(P<0.01),与单用NBI相比,两者敏感性及特异性亦有统计学差异(P<0.05)。结论 NBI或AFI比WLB在肺癌诊断方面具有更好的敏感性,且联合使用NBI+AFI比其它任何一种单用技术具有更高的敏感性和特异性优势。     

THP定位诊断早期非肌层浸润性膀胱癌

目的：研究THP（吡柔比星）对非肌层浸润性膀胱癌早期的定位诊断效果。方法：选择35例已诊断膀胱癌或高度怀疑尿路上皮癌患者。病人术前及术后复查时,30mgTHP溶入50m15％葡萄糖液中,灌入已排空的膀胱中,保留15分钟,排出THP,彻底冲洗膀胱。普通膀胱镜检查,有THP吸收的非肿瘤区域取活检,无THP吸收的部位随机活检。结果：35例患者中存在非肌层浸润性膀胱癌早期的共6例。结论：THP对非肌层浸润性膀胱癌早期的定位诊断效果明确,安全性好。     

RT-PCR法检测尿脱落细胞中XIAP的表达在膀胱癌诊断中的价值

目的:比较膀胱癌患者尿液脱落细胞中XIAP表达的RT-PCR检测法和常规尿脱落细胞病理学检测在膀胱癌诊断中的临床价值。方法:采用逆转录聚合酶链反应技术(RT-PCR)检测51例膀胱尿路上皮癌患者尿液脱落细胞中XIAP-mRNA的表达,同时行常规尿脱落细胞病理学检测,20例非肿瘤人员作为对照组。结果:实验组51例尿脱落细胞XIAP-mRNA RT-PCR检测阳性27例(53%),尿脱落细胞学病理学检测阳性12例(24%),对照组20例尿脱落细胞XIAP-mRNA检测阳性1例(5.0%),对照组尿脱落细胞病理学检测阳性0例(0%)。实验组RT-PCR检测膀胱尿路上皮癌患者尿脱落细胞中XIAP表达的敏感性高于尿脱落细胞病理学检测,差异有极显著统计学意义(P<0.01),实验组RT-PCR检测膀胱尿路上皮癌患者尿中XIAP表达的敏感性显著高于非肿瘤对照组,差异有极显著统计学意义(P<0.01)。结论:膀胱尿路上皮癌患者尿脱落细胞中XIAP表达的RT-PCR检测法较常规尿脱落细胞病理学检测更敏感,临床上作为膀胱癌的筛选方法,有一定的临床价值。     

应用荧光原位杂交技术检测膀胱癌的研究

目的应用荧光原位杂交((fluorescence in situ hybridization,FISH)技术检测膀胱癌患者尿液脱落细胞中染色体异常,评估FISH在中国人群中诊断膀胱癌的作用。方法2007年1月至2008年8月,随机留取20例良性前列腺增生症患者的新鲜尿液,用3号和7号、17号及p16位两组混合探针,通过在尿液脱落细胞标本上进行FISH检测,建立正常人群的阈值;其后随机留取30例门诊膀胱镜活检证实的膀胱癌患者的尿液,同时进行尿液脱落细胞的细胞形态学分析及FISH检测,对比检查结果。结果3号、7号和17号染色体非整倍性改变及p16位点异常正常阈值分别为8.5%、7.1%、6.8%和9.2%,FISH与细胞学检查总敏感性分别为76.6%和43.3%(P<0.05)。T_(is)及T_a、T_1患者FISH检测的敏感性分别为80.0%和64.2%,脱落细胞组织学检测显示敏感性分别为40.0%和35.7%;T_(2-3)患者FISH的敏感性为90.9%,而脱落细胞组织学检测为54.7%(P<0.05),低级别尿路上皮癌FISH及细胞学敏感性分别为68.4%和31.6%;高级别分别为90.9%和63.6%。结论与尿液脱落细胞组织学检测相比,对尿液脱落细胞进行FISH检测可以提高膀胱癌的诊断率,FISH可以作为诊断膀胱癌的一种无创伤的新方法。     

ADNP在膀胱尿路上皮癌组织中的表达及其临床意义

目的：探讨神经依赖性活性保护蛋白（ADNP）在膀胱尿路上皮癌中的表达情况及其临床意义。方法：收集中南大学湘雅医学院附属肿瘤医院2019 年6 月1 日至2019 年7 月15 日手术切除的膀胱癌及其配对的癌旁组织标本各28 例,采用qPCR检测20 例膀胱癌组织和癌旁组织的ADNP mRNA表达水平,WB检测其余8 对标本的ADNP蛋白表达水平。同时,回顾性分析我院2005 年1 月1 日至2007 年12 月31 日收治的膀胱尿路上皮癌患者221 例的临床病理资料,免疫组化染色方法检相应患者手术切除的石蜡标本中ADNP的表达情况,并收集同期因其他膀胱疾病而手术患者的非肿瘤膀胱组织切片用作对照。卡方检验分析ADNP表达与不同临床病理因素之间的相关性,Kaplan-Meier 法进行生存分析,Cox 比例风险回归模型对患者预后影响因素进行单因素及多因素分析。结果：膀胱尿路上皮癌组织中ADNP的转录和翻译水平均高于非肿瘤组织（均P<0.05）,且ADNP的表达量与膀胱癌的组织学分级、临床分期及患者存活状态有着相关性(P<0.05）。纳入的221 例患者随访中失访32 例,ADNP高表达较低表达的膀胱患者有着不良的预后（5 年OS：49.5% vs 78.6%,P<0.01;5 年PFS：40.0% vs 72.2% ,P<0.01;10 年OS：26.6% vs 58.6% ,P<0.01;10 年PFS：25.3% vs 47.9%,P<0.01）。Cox 单因素回归模型显示,ADNP表达量与膀胱癌的预后密切相关（P<0.05）;同时Cox 多因素回归也表明ADNP表达量（95% CI：1.300~2.905,P=0.001）是影响膀胱癌预后的独立危险因素。结论：ADNP在膀胱癌组织中的表达水平比非肿瘤的膀胱组织有显著的升高,组织学分级及临床分期与ADNP的表达水平有相关性,ADNP低表达的膀胱癌患者预后相对较好,ADNP有望成为膀胱癌的特异性治疗候选靶点。     

Fluorescent diagnostics of urinary bladder cancer

Introduction of optic markers in screening for cancer of the urinary bladder (UB) raises diagnostic significance of UB cystoscopy. Application of intravesical form of 5-aminolevulinic acid (5-ALA), precursor of photodynamically active protoporphirine IX, prevents complications in systemic use of tetracycline or hepatoprophirines. Fluorescent cystoscopy with 5-ALA (n = 59) was made in 51 patients treated in the Research Institute of Urology. UB cancer was detected in 32 patients. This procedure proved highly sensitive and specific (97.0 and 75.6%, respectively, being much more effective than standard cystoscopy and biopsy in the white light (85.1 and 81.4%, respectively). Specificity of fluorescent cystoscopy is much higher in detection of tumors and pretumor lesions (88.4%). Fluorescent diagnosis is expected to become a gold standard in the program of UB cancer detection.     

Role of 5-aminolevulinic acid in the detection of urothelial premalignant lesions

BACKGROUND: The authors evaluated the role of 5-aminolevulinic acid (5-ALA)-induced fluorescence endoscopy (AFE) in the detection of flat urothelial lesions in light of the suggestions made for flat neoplastic lesions within the 1999 World Health Organization (WHO) classification of urinary bladder tumors. METHODS: From 1995 to 2000, 713 patients underwent 1414 AFE procedures for the detection of transitional cell carcinoma of the bladder (TCCB). Fluorescence imaging was performed with an incoherent light source (D-light; 380-440 nm) that was filtered for efficient protoporphyrin IX excitation and with cystoscopes partially blocking reflected excitation light to enable fluorescence evaluation by a red/blue color contrast 2-3 hours after 50 mL of a 3% solution of 5-ALA was instilled into the bladder. In total, 3834 biopsy specimens (mean, 2.7 specimens per AFE procedure) were taken. RESULTS: Malignant disease was found in 1250 (32.6%) of all biopsies, with 304 biopsies (24.3%) showing carcinoma in situ (cis) and dysplasia II degrees (dys II) according to the previous diagnostic criteria of the WHO. Under prior conventional white-light endoscopy, 30.3% of specimens with dys II and 52.8% of specimens with cis had been missed. CONCLUSIONS: The current results suggest that 5-ALA may be more effective in the detection of flat urothelial lesions than the current diagnostic devices.     

Clinical significance of macroscopic 5-aminolevulinic acid (ALA)-inducer fluorescence in transurethral resection of non-invasive bladder cancer

Macroscopic fluorescence which is induced with aminolevulinic acid (ALA) allows visualizing of small flat tumors, carcinoma in situ, true neoplasm margins and dysplasias of the bladder. Following ALA instillation, cystoscopy was performed under both standard and blue light illumination. In a prospective randomized multicenter study, 102 patients underwent TUR of bladder tumor(s) either with white light or ALA-fluorescence. Significant reduction in the number of residual tumours was detected in 59% (p = 0.005) after 8 weeks, 3 months--in 58% (p = 0.002) and 6 months in 38% (p = 0.01) respectively.     

ALA fluorescent diagnosis of bladder cancer

Application of 5-aminolauvulin acid (ALA) fluorescence allows to detect not only exophytic tumors of the bladder but also flat, small tumors-satellites and preneoplastic changes of the bladder. 175 biopsies were performed in 53 patients with suspected superficial tumor of the bladder. 3 hours before surgery all the patients were intravesically instilled 50 ml 3% ALA solution. Cystoscopy employed white and blue light. Visual registration of exophytic masses and red fluorescence of the suspected sites was registered and consequently compared to the histological findings. 96 of 100 sites with malignancy/dysplasia showed red fluorescence. In 13% patients cancer and mucosal dysplasia were detected only under the blue light and were missed by standard cystoscopy. Residual red fluorescence of the resection margins was observed in 41% patients after TUR. Sensitivity of ALA-fluorescent detection reached 96%, specificity 52%. ALA-induced fluorescent diagnosis is more effective than standard cystoscopy. It is most effective in diagnosis of dysplasias, carcinoma in situ, flat, small, multiple superficial tumors of the bladder during primary TUR.     

Photodetection of cervical intraepithelial neoplasia using 5-aminolevulinic acid-induced porphyrin fluorescence

BACKGROUND: Screening for cervical carcinoma and its precursors is based on cervical cytology and diagnostic colposcopy. Despite the decrease in the incidence of cervical carcinoma in countries with a good screening program, this rate of decline is leveling off. Known problems are false-negative rates of cytology and low specificity of colposcopy. This clinical study examined the diagnostic potential of porphyrin fluorescence in patients with cervical intraepithelial neoplasia Grade 1-3 (CIN 1-3). METHODS: Sixty-eight women attending our colposcopy clinic underwent a gynecologic examination, including cytology, human papillomavirus (HPV) testing, and colposcopy. They received 10 mL 0.5% or 1.0% 5-aminolevulinic acid (5-ALA) topically. After 30-360 minutes, real-time image analysis was performed, and spectra were obtained from 685 sites. RESULTS: Due to rapid photobleaching, 0.5% 5-ALA proved ineffective for fluorescence assessment. Using 1% 5-ALA, the authors found that fluorescence intensities correlated with incubation time; however, fluorescence contrast showed a maximum at 60-90 minutes (ratio 11:1). HPV DNA positive lesions showed significantly higher fluorescence. Fluorescence imaging after 60-90 minutes achieved similar sensitivity and specificity compared with colposcopy in detecting CIN with 94% and 51% versus 95% and 50%, respectively. However, the specificity was markedly improved by fluorescence spectroscopy, achieving 75%. The evaluation of spectral measurements revealed significantly higher values for CIN compared with normal tissue and for CIN 2/3 compared with CIN 1 (P < 0.001). CONCLUSIONS: Using a time interval of 60-90 minutes after topical application of 1% 5-ALA, the authors observed specific porphyrin fluorescence of CIN. Fluorescence spectroscopy promises to become a valuable tool for the diagnosis of CIN.     

Diagnostic approach for cancer cells in urine sediments by 5‐aminolevulinic acid‐based photodynamic detection in bladder cancer

Bladder urothelial carcinoma is diagnosed and followed up after transurethral resection using a combination of cystoscopy, urine cytology and urine biomarkers at regular intervals. However, cystoscopy can overlook flat lesions like carcinoma in situ, and the sensitivity of urinary tests is poor in low‐grade tumors. There is an emergent need for an objective and easy urinary diagnostic test for the management of bladder cancer. In this study, three different modalities for 5‐aminolevulinic acid (ALA)‐based photodynamic diagnostic tests were used. We developed a compact‐size, desktop‐type device quantifying red fluorescence in cell suspensions, named “Cellular Fluorescence Analysis Unit” (CFAU). Urine samples from 58 patients with bladder cancer were centrifuged, and urine sediments were then treated with ALA. ALA‐treated sediments were subjected to three fluorescence detection assays, including the CFAU assay. The overall sensitivities of conventional cytology, BTA, NMP22, fluorescence cytology, fluorescent spectrophotometric assay and CFAU assay were 48%, 33%, 40%, 86%, 86% and 87%, respectively. Three different ALA‐based assays showed high sensitivity and specificity. The ALA‐based assay detected low‐grade and low‐stage bladder urothelial cells at shigher rate (68–80% sensitivity) than conventional urine cytology, BTA and NMP22 (8–20% sensitivity). Our findings demonstrate that the ALA‐based fluorescence detection assay is promising tool for the management of bladder cancer. Development of a rapid and automated device for ALA‐based photodynamic assay is necessary to avoid the variability induced by troublesome steps and low stability of specimens.     

Feasibility of Photodynamic Diagnosis for Challenging TURBt Cases Including Muscle Invasive Bladder Cancer,BCG Failure or 2nd-TUR

Background: Despite widely adopted standard methods for follow-up including cystoscopy plus cytology,recurrence rates of non muscle-invasive bladder cancer (NMIBC) have not improved over the past decades, stillranging from 60% through 70%. Hence, widely acceptable surveillance strategies with excellent sensitivity areneeded. Early recurrence has led to the development of a novel cystoscopy technique utilizing photodynamicdiagnosis (PDD). Although, no studies have evaluated the efficacy of PDD for patients of MIBC, BCG failure or2nd-transurethelial resection (TUR). Materials and Methods: The present study was performed from October2012 through May 2013. IRB approved 25 patients initially underwent a cystoscopy examination of white lightand blue light followed by the resection of tumors identified. Resections were performed from bladder mucosaareas considered suspicious at PDD, along with PDD negative normal bladder mucosa area resected by randombiopsy. Specimens were divided into two groups, PDD positive and negative. Primary endpoints were sensitivityand specificity. Results: A total of 147 specimens extracted from 25 patients were included in the analysis. Some45 out of 92 PDD-positive specimens were confirmed to have bladder cancer, and 51 out of PDD-negative 55specimens were confirmed to be cancer negative. The sensitivity of PDD was 91.8% (45/49) and specificity was52.0% (51/98). The sensitivity:specificity was 89.5% (17/19) : 47.6% (30/63) in 12 2nd-TUR patients, 90.5%(19/21) : 61.1% (11/18) in seven MIBC patients, and 95.0% (19/20) : 48.5% (16/33) in eight failed BCG cases.Conclusions: PDD-TURBT has high sensitivity to diagnose BC even for 2nd-TUR, MIBC or BCG failure cases.     

A comparative study of normal inspection, autofluorescence and 5-ALA-induced PPIX fluorescence for oral cancer diagnosis.

Fluorescence diagnosis aims to improve the management of oral cancer via early detection of the malignant lesions and better delimitation of the tumor margins. This paper presents a comparative study of normal inspection, combined fluorescence diagnosis (CFD) and its 2 main components, autofluorescence and 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PPIX) fluorescence. Biopsy-controlled fluorescence imaging and spectral analysis were performed on a total of 85 patients with suspected or histologically proven oral carcinoma both before and after topical administration of 5-ALA (200 mg 5-ALA dissolved in 50 ml of H(2)0). Fluorescence excitation was accomplished using filtered light of a xenon short arc lamp (lambda = 375-440 nm). As for CFD, a "streetlight" contrast (red to green) was readily found between malignant and healthy tissue on the acquired images. In terms of tumor localization and delimitation properties, CFD was clearly favorable over either normal inspection or its 2 components in fluorescence imaging. The performance of CFD was found to be impeded by tumor keratinization but to be independent of either tumor staging, grading or localization. In spectral analysis, cancerous tissue showed significantly higher PPIX fluorescence intensities and lower autofluorescence intensities than normal mucosa. There is a great potential for CFD in early detection of oral neoplasms and exact delimitation of the tumors' superficial margins and an advantage over white light inspection and each of its 2 main components. The method is noninvasive, safe and easily reproducible.     

Fluorescence-in-situ-hybridization in the Surveillance of Urothelial Cancers: Can Use of Cystoscopy or Ureteroscopy be Deferred?

Background: Fluorescence in situ hybridization (FISH) testing may be useful to screen for bladder carcinomaor dysplasia by detecting aneuploidy chromosomes 3, 7, 17 and deletion of the chromosome 9p21 locus in urinespecimens. This study aimed to assess the sensitivity, specificity, positive and negative predictive value of FISHin a multi-ethnic population in Asia. Materials and Methods: Patients with haematuria and/or past history ofurothelial cancer on follow-up had their voided urine tested with FISH. Patients then underwent cystoscopy/ureteroscopy and any lesions seen were biopsied. The histopathological reports of the bladder or ureteroscopicmucosal biopsies were then compared with the FISH test results. Results: Two hundred sixty patients wererecruited. The sensitivity and specificity of the FISH test was 89.2% and 83.4% respectively. The positive (PPV)and negative predictive values (NPV) were 47.1% and 97.9%. By excluding patients who had positive deletionof chromosome 9, the overall results of the screening test improved: sensitivity 84.6%; specificity 96.4%; PPV75.9% and NPV 97.9%. Conclusions: UroVysion FISH has a high specificity of detecting urothelial cancer ordysplasia when deletion of chromosome 9 is excluded. Negative UroVysion FISH-tests may allow us to conservehealth resources and minimize trauma by deferring cystoscopic or ureteroscopic examination.