电子膀胱软镜及窄带光谱成像技术在非肌层浸润性膀胱癌诊断中的应用研究

Application of Flexible Cystoscopy and Narrow-band Imaging in the Diagnosis of Non-muscle Invasive Bladder Cancer

目的研究窄带光谱成像(NBI)电子膀胱软镜在非肌层浸润性膀胱癌(NMIBC)诊断中的应用价值。方法将115例NMIBC患者分为A组和B组。A组患者先行普通白光(WLI)膀胱镜检查,后行NBI电子膀胱软镜检查;B组患者行WLI膀胱镜检查后,再次进行WLI膀胱镜检查。分别记录前后2次膀胱镜检查观察到的肿瘤位置、数目、大小。对可疑病变取活检并送病检,比较两组患者不同镜检方法的诊断效能。结果本研究共纳入115例患者,共确诊NMIBC患者97例。A(WLI-NBI)组62例,共取活检157处,病理确诊阳性病灶105处,确诊55例;二次镜检取检37处,病理确诊阳性病灶24处,二次镜检阳性率64.8%,二次镜检阳性病灶占比为22.8%,新诊断患者7例。B(WLI-WLI)组53例,共取活检129处,病理确诊阳性病灶81处,确诊42例;二次镜检取检25处,病理确诊阳性病灶8处,二次镜检阳性率32.0%,二次镜检阳性病灶占比为9.8%,新诊断患者2例。A组患者二次镜检阳性率、二次镜检阳性病灶比例均高于B组(P均<0.05)。WLI膀胱镜的诊断敏感度为87.3%,特异度为57.1%;NBI电子膀胱软镜诊断敏感度为96.4%,特异度为42.9%。结论NBI电子膀胱软镜可提高NMIBC的检出率,且WLI膀胱镜首次观察、NBI电子膀胱软镜二次观察可降低NMIBC的漏诊率。

Objective To investigate the application value of flexible cystoscopy and narrow-band imaging(NBI)in the diagnosis of non-muscle invasive bladder cancer.Methods A total of 115 patients with NMIBC were divided into group A and group B.Patients in group A were detected with WLI-cystoscopy plus second look flexible NBI-cystoscopy.Patients in group B were detected with WLI-cystoscopy plus second look WLI-cystoscopy.The location,number and size of tumors observed by cystoscopy before and after were recorded.All the suspected lesions were biopsied.The diagnostic efficacy of different microscopy examination was compared between the two groups.Results A total of 115 patients were included in this study and 97 patients with NMIBC were diagnosed.There were 62 patients in group A,and 157 biopsies were taken.Histopathologic examination showed that 105 of them were of urothelial cell carcinoma.And 55 people were diagnosed with NMIBC,among them 37 lesions were detected by the secondary examination,and 24 lesions were confirmed to be positive by pathology.The positive rate of the secondary examination was 64.8%,the proportion of positive lesions in secondary endoscopy was 22.8%,with 7 newly diagnosed patients.There were 53 patients in group B,a total of 129 biopsies were taken.Histopathologic examination showed that 81 of them were of urothelial cell carcinoma,42 people were diagnosed with NMIBC.Among them,25 lesions were detected by the secondary examination,and 8 lesions were confirmed to be positive by pathology.The positive rate of the second examination was 32.0%,the proportion of positive lesions in secondary endoscopy was 9.8%,with 2 newly diagnosed patients.The positive rate of secondary microscopy and the proportion of positive lesions in group A were higher than those in group B(P all<0.05).The sensitivity and specificity of WLI-cystoscopy were 87.3%and 57.1%respectively.The sensitivity and specificity of NBI-cystoscopy were 96.4%and 42.9%respectively.Conclusion Flexible NBI-cystoscopy can improve the detection rate of non-muscle invasive bladder cancer,and after the first observation of WLI-cystoscopy,the second observation of flexible NBI-cystoscopy can significantly reduce the missed diagnosis rate of non-muscle invasive bladder cancer.