[Meta-analysis of fluorescence in situ hybridization and cytology for diagnosis of bladder cancer].

BACKGROUND AND OBJECTIVE Currently, cystoscopy and urine cytology are standard modalities in therapy monitoring and follow-up of bladder cancer. Cystoscopy is an invasive and uncomfortable procedure while cytology has a limited value because it is operator-dependent and has a low sensitivity. This study was to assess the accuracy of fluorescence in situ hybridization(FISH) in detecting bladder cancer by comparing it with cytology using systemic analyses of studies published in both English and Chinese. METHODS Cochrane systematic evaluation was used to search through MEDLINE, EMBASE, Cochrane Library, CMCC and CNKI for studies regarding FISH and cytology in the detection of bladder cancer. Data were extracted and analyzed using software MetaDiSc1.4. RESULTS In total 242 relevant studies were searched, of which 12 studies were enrolled and 3430 patients were included. Heterogeneity, except for threshold effects, was found within these studies. A meta-analysis was performed using the random effect model. Pooled accuracy indicators like sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio of FISH and cytology were 74% (71%-77%) vs. 57% (54%-61%), 88 % (86%-90%) vs. 85 % (83%-87%), 6.18 (3.56-10.73) vs. 4.15 (2.78-6.20), 0.29 (0.19-0.45) vs. 0.51(0.41-0.63) and 24.17 (9.33-62.64) vs. 9.59 (5.91-15.57), respectively. The sensitivity of both FISH and cytology were increased with the increase of tumor grade and stage. The areas under summary receiver operating characteristics (SROC) curve were 0.8938 and 0.7847, and the Q indices were 0.8247 and 0.7226 for FISH and cytology, respectively. CONCLUSIONS FISH has a high accuracy in detecting bladder cancer. But its sensitivity in detecting high-stage bladder cancer is lower than that of cytology. Although FISH can not replace traditional urine cytology, it can be used as an important adjunct in the preoperative detection and postoperative monitoring of bladder cancer.