Why Was A FISH Test Ordered ?

9 months 1 week ago #60439 by joea73
Replied by joea73 on topic Why Was A FISH Test Ordered ?
Thanks Stu for the update and sharing with us the report on uFISH, and congrats on the uFISH confirmation of no high grade urothelial carcinoma and likelyfood of no low grade urothelial carcinoma.

Apprently, around 2015, the international pathologists group came up The Paris System for Reporting Urinary Cytology in order to standardize the terminology in cytology report. The new reporting system focuses on the detection of high-grade urothelial carcinoma (HGUC). Their rationale is that they acknowledge that cytology has a high sensitivity of detecting UGUC but with a poor sensitivity for low-grade urothelial carcinoma (LGUC). Also, LGUC is associated with an overall good prognosis - recurrence by rare progression but HGUC is associated with a worse prognosis including a higher rate of progressing to muscle tissue. I have noticed that the uFISH report from Mayo clinic says also that FISH may miss some low-grade urothelial carcinomas. Also, the motivation of the new reporting system tries to improve pathologic findings and outcome probability. Pathologists actively use the terms ‘suspicious’, ‘indeterminate’, or ‘atypical’ – all too often with resultant failure to provide a clear diagnostic and therapeutic path for clinicians.

Diagnostic Categories and Morphologic Criteria of The Paris System is as follows.

1 Nondiagnostic/unsatisfactory
2 Negative for high-grade urothelial carcinoma (NHGUC)
3 Atypical urothelial cells (AUC)
4 Suspicious for high-grade urothelial carcinoma (SHGUC)
5 High-grade urothelial carcinoma (HGUC)
6 Low-grade urothelial neoplasm (LGUN)
7 Other: primary and secondary malignancies and
miscellaneous lesion

Attached is the algorithm (simple version) of how to classify the urine cytology test result

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9 months 1 week ago #60435 by JigStep
Replied by JigStep on topic Why Was A FISH Test Ordered ?
Thanks Joea73. My FISH test showed no evidence of urothelial carcinoma. Here are a couple of comments from the report that line up with your explanations:

This test result does not rule out the possibility that the patient may have a low-grade (i.e. grade 1 or 2) non-invasive papillary urothelial carcinoma. Some patients with low grade non-invasive papillary urothelial carcinoma do not have abnormalities with this FISH test.

Fluorescence in situ hybridization (FISH) with centromere probes for chromosomes 3 (D3Z1), 7(D7Z1), 17(D17Z1), and a locus specific probe for 9p21.

They sent the sample to Mayo in MN for processing.

I read all your posts for the technical info.

Stu

7/18 Gross hematuria
8/18 TURBT, papillary urothelial carcinoma, T1 LG
12/18 TURB, benign urothelial mucosa, features consistent with cystitis cystica
9/19 TURBT, HG papillary urothelial carcinoma, noninvasive
6/20 TURB. Negative for malignancy. Marked denudation, inflammation, and procedural artifact

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9 months 1 week ago #60433 by joea73
Replied by joea73 on topic Why Was A FISH Test Ordered ?
Below are short videos to learn about the process of cytology and uFISH.

Cytology




FISH



The result of the FISH test shows four fluorescence highlights (red, green, blue, and yellow) for abnormalities in chromosomes. Red: Chromosome 3, Green: Chromosome 7. Blue: Chromosome 17, Yellow: Chromosome 9.

Attached is the picture of a FISH / cytology test result.

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9 months 1 week ago #60431 by joea73
Replied by joea73 on topic Why Was A FISH Test Ordered ?
Glad to know that you are getting FISH. As Allan said, FISH' reliability is that great, but FISH and Immusys are the only FDA-approved urine tests for bladder cancers to be used adjuvant to cystoscopy mainly to check the recurrence of bladder cancer. Cytology and FISH methods of finding cancerous cells in urine are totally different. Cytology depends upon the experience of a pathologist looking through a microscope and FISH checks the abnormalities of chromosomes 3,7,17 and also checks if a specific gene is missing from chromosome 9. As we know, each cell has 23 pairs of chromosomes, each has a DNA. Cancer cells have several mutations in the DNA. Chromosomes 3,7,17 were known to have genes that cause bladder cancer. In the case of chromosome 9, it is known that a certain part of the DNA is missing, there is a high frequency of cancers, including bladder cancer. Chromosome 17 includes the famous p53 tumor suppressor gene. The loss of its function because of mutations and the loss of the p53 gene have been found in almost 50% of muscle-invasive bladder cancer and also in a high percentage of HG non-muscle-invasive bladder cancer. The drawbacks of FISH is more expensive, it is likely that the urine sample needs to be sent to some lab that does FISH often. Also, the technology is old. In 2001, the cost of analyzing a human genome (entire DNA analysis of one person) cost near $100M. So, there was limited information about the relationship between gene mutations and bladder cancer. FISH was developed in that limited environment. Now, it costs less than $1,000 and getting cheaper. So, many researchers are doing genome analysis for bladder cancer and new urine tests are being developed by various companies. Among them, CxBladder has shown to be very promising. Their website says it is now covered by Medicare. The next time you meet with your pathologist, please check with him about new urine tests and let us know. FYI, there are now over 350 genes that have been identified relating to bladder cancer.


www.cxbladder.com/us/

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9 months 1 week ago #60420 by JigStep
Replied by JigStep on topic Why Was A FISH Test Ordered ?
My Uro ordered a FISH -- in addition to the normal cytology -- with my recent cystoscopy. I was curious, too, since he had not ordered one in the 2 1/2 years I've been seeing him. He said he does it every 1 to 2 years as an additional check.

7/18 Gross hematuria
8/18 TURBT, papillary urothelial carcinoma, T1 LG
12/18 TURB, benign urothelial mucosa, features consistent with cystitis cystica
9/19 TURBT, HG papillary urothelial carcinoma, noninvasive
6/20 TURB. Negative for malignancy. Marked denudation, inflammation, and procedural artifact
The following user(s) said Thank You: BigRIJoe

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9 months 2 weeks ago #60411 by Alan
Replied by Alan on topic Why Was A FISH Test Ordered ?
All I can add is the FISH test is considered even more prone to false "positives". Almost sounds like the pathologist is confused as anyone. I will be curious where this leads, if anywhere.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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