非肌层浸润性膀胱癌经尿道切除术中随机黏膜活检的临床病理特征

Clinical and pathological characteristics of random mucosal biopsy in patients with non-muscle invasive bladder cancer

目的评估非肌层浸润性膀胱癌经尿道切除术中同期行随机黏膜活检的临床病理特征及其对后续治疗策略选择的影响。方法对200例非肌层浸润性膀胱癌患者行经尿道膀胱肿瘤切除术+随机多点黏膜活检,活检位置依次包括:膀胱前壁、后壁、左侧壁、右侧壁、顶壁、三角区、颈部正常或可疑黏膜,活检标本分别单独装袋送病理学检查,回顾性分析其临床病理特征。结果在200例随机多点黏膜活检病理中,异常者31例(15.5%),包括原位癌12例(6.0%),T1 2例(1%),Ta 1例(0.5%),不典型增生12例(6.0%),鳞状化生4例(2.0%)。在31例异常病理中,以三角区、颈部黏膜活检阳性率最高,分别为14例(45.1%)和13例(41.9%),其中有7例黏膜活检阳性的部位与原发肿瘤一致。对随机活检阳性病例患者的性别、年龄、术前肿瘤数目、肿瘤直径、肿瘤临床分期、肿瘤病理分级等变量进行单因素、多因素分析。结果显示:与Ta期相比,T1期随机活检的阳性率显著升高(P=0.034),其余各项均无明显统计学差异。最终有6例患者因随机活检结果而改变了治疗方案。结论非肌层浸润性膀胱癌经尿道切除同期行随机黏膜活检简便易行,可发现伴随的异常病变,有利于确认高危患者,并为肿瘤切除术后选择最佳的辅助治疗或行膀胱根治切除提供依据,建议可在临床工作中常规实施。

ObjectiveTo evaluate the clinical and pathological characteristics of random mucosal biopsy in patients with non-muscle invasive bladder cancer （NMIBC） after transurethral resection （TUR）, and to explore its effects on the choice of further treatment strategies. MethodsA total of 200 consecutive patients with NMIBC who underwent TUR and random mucosal biopsies of the bladder were enrolled. The anterior wall, posterior wall, left wall, right wall, dome, trigone and bladder neck were examined. ResultsOf all cases, histological abnormalities were observed in 31 cases, including carcinoma in situ （CIS） in 12 （6.0%） cases, T1 in 2 cases（1%）, Ta in 1 case（0.5%）, untypical hyperplasia in 12 cases （6.0%）, and squamous metaplasia in 4 cases（2.0%）. In these 31 cases, the positive rate of abnormality in the trigone （14 cases, 45.1%） and bladder neck （13 cases, 41.9%） was the highest, including respectively, and in 7 cases, the site of positive biopsy was consistent with the primary tumor. Univariate and multivariate analyses of the gender, age, number of tumors, tumor diameter, stage, pathological grade showed that, only the positive rate of random biopsy in patients with T1 stage was significantly higher than that in patients with Ta stage （P=0.034）. There were no statistically significant differences among the other parameters. Altogether 6 patients changed therapeutic strategies. ConclusionRandom biopsy is simple to perform and helpful to identify patients with high risk of disease progression and recurrence. Therefore, it is better performed as a routine step during TUR of primary NMIBC.