窄带成像电子膀胱软镜在复发性膀胱癌精准活检的应用价值

朱智能; 袁敬东; 章传华

doi:10.13201/j.issn.1001-1420.2019.07.015

窄带成像电子膀胱软镜在复发性膀胱癌精准活检的应用价值

- 华中科技大学同济医学院附属武汉市中西医结合医院武汉市第一医院泌尿外科(武汉, 430022)
基金项目:
湖北省自然科学基金资助项目（编号2016CFB300）

详细信息

通讯作者: 章传华,E-mail:uro0865@outlook.com

中图分类号: R737.1

收稿日期: 2018-05-04

Application value of narrow-band imaging flexible cystoscopy in precise biopsy of recurrent bladder cancer

- Department of Urology, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan No. 1 Hospital, Wuhan, 430022, China

More Information

Corresponding author: ZHANG Chuanhua, E-mail: uro0865@outlook.com

Received Date: 04 May 2018

摘要

摘要: 目的：研究窄带成像（NBI）技术结合电子膀胱软镜在复发性膀胱癌精准活检的应用价值。方法：临床观察膀胱尿路上皮癌保留膀胱术后定期随访患者474例，采用Olympus ExeraⅡ电子膀胱软镜系统，分别在普通白光成像（WLI）和NBI视野下检查，采用随机化法顺序，观察时间相同。分别对2种视野下膀胱内所见扁平状和乳头状可疑新生物取活检进行病理学诊断，并记录肿瘤的数目和直径大小，比较2种检查方法膀胱肿瘤检出率。结果：474例术后随访患者中，经病理检查确诊为膀胱尿路上皮癌166例（35%），其中146例（88%） WLI和NBI均可发现，另20例只能通过NBI发现。NBI发现扁平状病变73例，病理学诊断尿路上皮癌54例，不典型增生11例，炎症反应8例；乳头状病变390例，病理学诊断尿路上皮癌359例，其中直径≤4mm肿瘤94例，直径>4mm肿瘤265例。WLI发现扁平状病变75例，病理证实尿路上皮癌43例，不典型增生12例，炎症反应20例；乳头状病变385例，病理学诊断尿路上皮癌327例，其中直径≤4mm的63例，直径>4mm肿瘤264例。NBI下共取活检463例，癌组织413例，阳性率89.2%；WLI下共取活检460例，癌组织370例，阳性率80.4%。NBI发现扁平癌较WLI多11例，NBI发现≤4mm乳头状癌较WLI多31例，两组阳性检出率比较差异有统计学意义（P<0.05）。结论：NBI电子膀胱软镜能显著提高对膀胱内微小病变和扁平病变的阳性检出率，在复发性膀胱癌精准活检和早期诊断中具有应用价值。
- 尿路上皮癌 /
- 膀胱镜检查 /
- 窄带成像 /
- 活组织检查
Abstract: Objective: To investigate the application value of narrow-band imaging (NBI) flexible cystoscopy in precise biopsy of recurrent bladder cancer.Method: Four hundred and seventy-four patients had undergone transurethral resection of superficial transitional cell carcinoma and had been followed up.NBI flexible cystoscopy and conventional white-light imaging (WLI) flexible cystoscopy with the same instrument (Olympus ExeraⅡ endoscopy system) were both performed, and highly suspected bladder papillary lesions and flat lesions were detected respectively in both NBI and WLI image to compare the diagnostic accuracy between them.Result: Among 474 patients postoperative followed-up, bladder urothelial carcinoma was confirmed pathologically in 166 cases, 146 cases were detected by both WLI and NBI and another 20 cases only by NBI cystoscopy.Seventy-three flat lesions were harvested by NBI cystoscopy, 54 were confirmed pathologically urothelial carcinoma, 11 were atypical hyperplasia, 8 were inflammatory reaction, and 390 papillary lesions were harvested by NBI cystoscopy, 359 were confirmed pathologically urothelial carcinoma, 94 tumors of 4 mm diameter or less and 265 tumors above 4 mm diameter of them.Seventy-five flat lesions were harvested by WLI cystoscopy, 43 were confirmed pathologically urothelial carcinoma, 12 were atypical hyperplasia, 20 were inflammatory reaction, and 385 papillary lesions were harvested by WLI cystoscopy, 327 were confirmed pathologically urothelial carcinoma, 63 tumors of 4 mm diameter or less and 264 tumors above 4 mm diameter of them.In total, 463 lesions were detected in NBI and 413 lesions were bladder urothelial carcinoma.Positive rate was 89.2%.Four hundred and sixty lesions were detected in WLI and 370 lesions were bladder urothelial carcinoma.Positive rate was 80.4%.NBI cystoscopy detected additional 11 flat tumors and 31 papillary tumors of 4 mm diameter or less compared with WLI cystoscopy (P <0.05).Conclusion: Compared with WLI, NBI flexible cystoscopy increases the detection rate in precise biopsy of recurrent bladder cancer.
- urothelial carcinoma /
- cystoscopy /
- narrow-band imaging /
- biopsy

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