NBI技术结合电子软膀胱镜在膀胱肿瘤早期诊断中的应用研究

Application of Narrow-Band Imaging Flexible Cystoscopy in the Diagnosis of Bladder Carcinoma in the Early Period

目的:评估窄带成像(NBI)技术结合电子软膀胱镜(简称NBI膀胱镜)在膀胱肿瘤早期诊断中的应用价值。方法:2009年1月～5月对85例早期膀胱肿瘤或癌前病变患者,首先使用标准白光(WLI)膀胱镜进行观察,接着使用NBI膀胱镜进行观察,均记录观察到的乳头状肿瘤个数,最后取活组织检查并进行病理学诊断。对比NBI膀胱镜与WLI膀胱镜在膀胱肿瘤早期诊断中的检出率。结果:NBI技术能够提供更加清晰的膀胱肿瘤的图像,特别是肿瘤组织与正常膀胱黏膜的边界。85例中包括乳头状Ta期膀胱肿瘤76例,原位癌6例,重度不典型增生3例。使用WLI膀胱镜:Ta期膀胱肿瘤76例检查出肿瘤个数为178,原位癌检查出2例,重度不典型增生检查出1例;使用NBI膀胱镜:Ta期膀胱肿瘤76例检查出肿瘤个数214,原位癌检查出6例,重度不典型增生检查出3例;检出率分别提高了20.2%,200%,200%。结论:与WLI膀胱镜相比,NBI膀胱镜的应用能更清晰的显示肿瘤组织与正常膀胱黏膜的边界,提高早期膀胱癌及癌前病变的诊出率,降低漏诊率。

Objective：To investigate application value of narrow-band imaging （NBI） cystoscopy in the diagno- sis of bladder carcinoma in the early period. Methods：From January to May 2009, we evaluated 85 patients in the early period for bladder carcinoma or precancerous lesion by whit-light imaging （WLI） cystoscopy, followed by NBI cystoscopy as a further procedure, using the same video-cystoscope（OLYMPUS CYF-VA2）. Then number of tumors visualized by WLI or NBI cystoscopy were imaged, recorded, and then biopsied or subsequently treated by transurethral resection with pathological examination. The diagnosis results of NBI cystoscopy were compared with WLI cystoscopy results. Results： NBI provided a much clearer view of bladder carcinoma and in particular their border between tumor tissue and normal tissue. In all of 85 patients in the early period, there are 76 cases of Ta bladder carcinoma （BC）, 6 carcinoma in situ （TIS） and 3 severe dysplasia. In the 76 patients with Ta BC, the numbers of the tumors were 178 detected by WLI, and 214 by NBI. In the 6 patients with TIS, 2 detected by WLI, and 6 by NBI. In the 3 patients with severe dysplasia, 1 detected by WLI, and 3 by NBI. The rates of diagnosis raised 20.2%, 200%, 200% respectively. Conclusions：Compared with WLI cystoscopy, NBI cystoscopy provided even more image of BC especially their border between tumor tissue and normal tissue. NBI improved the detection of BC or precancerous lesion in the early period over standard WLI cystoscopy with higher rate of diagno sis or lower rate of missed diagnosis.