目的 探讨多色荧光原位杂交技术( M-FISH)在尿脱落细胞学阴性膀胱癌患者术后随访监测中的应用价值. 方法 收集接受经尿道膀胱肿瘤切除术后的膀胱尿路上皮癌患者76例,术前、术后随访尿脱落细胞学检查均阴性,分别采用膀胱镜、M-FISH进行术后随访监测.结果 76例患者中14例(18.4%)复发,M-FISH仅检出3例(3.9%)复发,漏诊11例(14.5%). 膀胱镜检查结果阴性54例,复发1例(低级别),M-FISH检查结果阳性. 膀胱镜检查结果可疑12例,复发4例(低级别2例、高级别2例) ,M-FISH检查结果阳性1例(低级别). 膀胱镜检查结果阳性10例,复发9例(低级别5例、高级别4例) ,M-FISH检查结果阳性1例(高级别). 膀胱镜检查结果阴性、M-FISH检查结果为阳性预测复发的敏感性为100%、特异性94 .3%,阳性预测值25%,阴性预测值100%. 膀胱镜检查结果可疑、M-FISH检查结果为阳性预测复发的敏感性为25%、特异性87.5%,阳性预测值50%,阴性预测值70%. 膀胱镜、M-FISH检查结果均为阳性预测复发的敏感性为11.1%、特异性100%,阳性预测值100%,阴性预测值11 .1%. 结论 M-FISH检测在尿脱落细胞学阴性膀胱癌患者术后随访复发中的检出率不高,经济效益低,不考虑作为膀胱癌术后随访的常规监测项目.%Objective To evaluate the application value of multicolor fluorescence in situ hybridization ( M-FISH) in postoperative follow-up monitoring of bladder cancer patients with negative urine cytology .Methods A total of 78 patients with urothelial cancer who were treated by transurethral resection of the bladder were included in this study .All of them had negative urine cytology .The cystoscopy and M-FISH were used to monitor the recurrence of the disease , and the results were compared.Results In 76 patients, 14 cases recurred (18.4%).M-FISH only detected 3 cases of recurrence (4%), and 11 cases of missed diagnosis (14.5%).Cystoscopy showed 54 cases with negative results , 1 case of recur-rence (low level), and the M-FISH showed positive results.Cystoscopy showed 12 cases were suspicious and 4 cases of re-currence (2 cases of low level, 2 cases of high level), and M-FISH showed 1 case with positive results (low level).Cysto-scopy showed 10 cases with positive results , 9 cases of recurrence ( 5 cases of low level , 4 cases of high level ) , and M-FISH showed 1 case with positive results ( high level ) .For that cystoscopy showed negative results , M-FISH showed posi-tive results, the sensitivity of predicting recurrence was 100%, the specificity was 94.3%, the positive predictive value was 25%, and the negative predictive value was 100%.For that cystoscopy showed suspicious results , M-FISH showed positive results, the sensitivity of predicting recurrence was 25%, the specificity was 87.5%, the positive predictive value was 50%, and the negative predictive value was 70%.For that cystoscopy showed positive results , M-FISH showed posi-tive results, the sensitivity of predicting recurrence was 11.1%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 11.1%.Conclusions M-FISH assay in postoperative follow-up monito-ring of bladder cancer patients with negative urine cytology had a low detection rate and low economic benefits .It was not considered as a follow-up routine monitoring project in bladder cancer surveillance after transurethral resection .
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