窄带显像膀胱镜对膀胱肿瘤手术前后病理核分级差异的影响

The influence of narrow-banding imaging cystoscopy in the pathological difference between biopsy and operation

目的 探讨窄带显像膀胱镜能否减少膀胱肿瘤手术前后病理核分级的差异.方法 采用WHO/ISUP 2004病理分级标准并结合临床情况,对205例膀胱肿瘤术前活检病理、术后病理分级等进行分析.对接受保留膀胱手术的患者进行随访并观察膀胱肿瘤复发情况.结果 白光膀胱镜组109例,术前G0 23例,G1 60例,G2 22例,G3 4例;术后G0 15例,G1 41例,G2 31例,G3 22例;活检低估51例（46.8%）,高估7例（6.4%）,一致51例（46.8%）.窄带显像膀胱镜组96例,术前G0 15例,G1 45例,G2 30例,G3 6例;术后G0 14例,G1 21例,G2 46例,G3 15例;活检低估45例（46.9%）,高估14例（14.6 %）,一致37例（38.5%）,两组相比差异无统计学意义.但单独观察G1亚组,窄带显像膀胱镜G1组低估率高于白光膀胱镜G1组（62.2% vs 41.7%）,窄带显像膀胱镜G1组一致率低于白光膀胱镜G1组（24.4% vs 50.0%）,两组差异有统计学意义（χ2=7.067,P=0.029）.行白光膀胱镜者平均随访33个月（4～62个月）,复发38例;行窄带显像膀胱镜者平均随访15个月（3～32个月）,复发9例,两组差异有统计学意义（χ2=5.25,P=0.02）.结论 窄带显像膀胱镜不能减少膀胱肿瘤术前活检分级低估现象.

Objective To investigate the role of narrow-band imaging cystoscopy in the patho- logical difference between biopsy and operation. Methods 205 bladder cancer patients were divided into two groups.. 109 in white light cystoscopic biopsy group and 96 in narrow-band imaging cysto- scopic biopsy group. The pathological difference before and after operation between two groups were compared. Results In white light cystoscopic biopsy group, 23, 60, 22, 4 cases before operation diagnosed with Go, G1 , G2, 63 while 15, 41, 31, 22 cases after operation diagnosed with Go, G1 , G2 , G3. There were 51 cases （46.8%） with underestimated histologie grade, 7 cases （6.4%） over- estimated and 51 cases （46.8%） matched. In narrow-band imaging cystoscopic biopsy group, 15, 45, 30, 6 cases diagnosed with G0, G1, G2, G2 before operation while 14, 21, 46, 15 cases with Go, GI, G2, G3 after operation. There were 45 cases （46. 9%） with underestimated histologic grade, 14 cases （14. 6%） overestimated and 37 cases （38. 5%） matched. No difference could be found between these two groups. But when concerning G1 subgroup, 28 cases （62.2%） were under- estimated histologic grade in narrow-band imaging cystoscopic biopsy group comparing to 25 cases （41.7%） in white light biopsy group, x2=7.067,P=0.029. After follow up for mean 15 months, white light cystoscopic biopsy group recurrent for 38 cases while narrow-band imaging group recur- rent only 9 cases,x2= 5.25, P= 0.02. Conclusions Though narrow-banding imaging cystoscopy could not decrease underestimated cases, but it could find more low grade lesions especially G1 grade that would be confirmed having more malignancy after operation.