방광암 환자에서 Fluorescence In Situ Hybridization 검사의 임상적 유용성 = Clinical Usefulness of Fluorescence In Situ Hybridization for the Detection of Bladder Cancer

다국어 초록 (Multilingual Abstract)

Background : Early detection of bladder cancer and its recurrence is the key to long term survival in patients. However, because of nonspecific symptoms, it is difficult to verify such assumption. The UroVysion fluorescence in situ hybridization (FISH) assay (Vysis, Downers Grove, IL, USA) is a new method to detect early bladder cancer. It can detect specific genetic alterations (aneuploidy of chromosome 3, 7, 17, and loss of 9p21) observed in bladder cancer. To investigate clinical usefulness, we evaluated UroVysion on bladder cancer patients with various status. Methods : A total of 56 patients were evaluated. Single voided urine specimens were obtained, and four types of probes (CEP3, CEP7, CEP17, and LSI9p21) were applied to each specimen according to the conventional FISH method. The results were interpreted according to the manufacturer’s criteria. Results : Of the 56 cases evaluated, 33 were being followed after treatment, 8 were newly diagnosed with bladder cancer, 5 had recurred, and 10 had hematuria with no evidence of cancer. The overall sensitivity of FISH, BTA stat test, and urine cytology was 71.4%, 57.1%, and 57.1%, and the specificity was 94.3%, 97.3%, and 89.7%, respectively. Especially, the sensitivity of FISH was 75% (6/8) in the newly diagnosed patients and 60% (3/5) in recurrent cases. A false positivity in FISH was shown in patients with urinary stone. Conclusions : FISH assay is the most sensitive method in the detection of bladder cancer, and also shows a good specificity. If other tests are done simultaneously, FISH assay will be very useful in detecting bladder cancer . However, whether FISH can replace cystoscopy is yet to be assessed.

국문 초록 (Abstract)

배경 : 방광암의 조기 진단은 장기 생존율에 가장 큰 영향을 미치지만 초기에 방광암을 진단하기는 쉽지 않다. 형광 동소 교잡법(UroVysion)은 방광암의 조기 진단과 재발을 초기에 검출하는데 도움을 줄 수 있는 새로운 검사법으로 방광암 발생에 관여한다고 알려진 염색체 3, 11, 17의 이수성과 염색체 9p21의 소실을 찾아내는 검사법이다. 저자들은 FISH 검사의 임상적 유용성을 알아보기 위해 여러 가지 상태의 환자를 대상으로 기존의 방광암 진단방법인 BTA stat 검사와 요세포검사를 비교하여 보았다.방법 : 비뇨기과 외래를 방문한 56명의 환자를 대상으로 검체는자연 배설뇨를 이용하였다. FISH는 CEP3, CEP7, CEP17, 그리고 LSI9p21의 4종류의 표지자를 사용하였다. 결과의 판독은 Vysis사에서 제시한 기준에 따라 시행하였다.결과 : 전체 환자 56명 중 방광암 진단 후 추적 관찰중인 환자3명, 처음으로 방광암을 진단받은 환자 8명, 추적 중 재발한 환자 5명과 혈뇨를 보이나 종양이 발견되지 않은 환자 10명이었다.FISH 검사, BTA stat 검사, 요세포 검사의 민감도는 각 71.4% ,57.1%, 57.1%이며, 특이도는 94.3%, 97.3%, 89.7%이었다. 특 히FISH 검사는 방광암이 처음 발견된 경우 75%의 민감도 (6/8)를보였고, 방광암 재발인 경우는 60%의 민감도(3/5)를 보였다. FISH위양성을 보인 1예는 요로결석인 것으로 밝혀졌다.
결론 : 방광암 환자의 진단에 있어서 FISH 검사는 가장 높은 민감도를 보였으며 특이도는 BTA stat 검사보다는 낮게 나타났지만 좋은 결과를 보였다. 기존의 방광암을 진단하는 검사들과 FISH검사를 병행하여 시행할 경우 방광암의 조기진단이나 재발을 초기에 발견하는 데 임상적으로 유용할 것으로 생각된다. 그러나 이와같은 비침습적인 검사가 방광경 검사를 대신할 수 있을지에 대해서는 추가 연구가 행해져야 할 것 같다.

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