经直肠常规超声及超声造影对非肌层浸润性膀胱癌诊断效能的研究

The role of transrectal ultrasound and contrast-enhanced ultrasound in diagnosis of non-muscle-invasive bladder cancer

目的:本研究探讨经直肠超声(transrectal ultrasound,TRUS)联合经直肠超声造影(transrectal contrastenhanced ultrasound,TR-CEUS)对非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的诊断效能,并与经腹部超声(transabdominal ultrasound,TAUS)进行比较。方法:回顾并分析2019年12月—2021年2月因膀胱病变入院诊治患者的影像学资料。患者在经尿道膀胱肿瘤切除术前行超声检查,包括TAUS、TRUS及TR-CEUS,以膀胱镜检查及手术后病理学检查结果为金标准。结果:按照纳入标准,本研究共纳入43例患者的65个病灶,其中44个为恶性(Ta~T1期膀胱癌),21个为良性。良恶性病变最大直径在组间差异无统计学意义[5(5,13)mm vs 8(5,12)mm]。TRUS较TAUS检出更多NMIBC病灶(90.9%vs 68.2%,P=0.008),以直径≤5 mm组间差异为著(P=0.008);相较TAUS,TRUS更多检出位于膀胱三角区、侧壁及底壁病变(P=0.010)。TR-CEUS较TRUS提高病变与肌层分界的评估准确度(92.7%vs 60.0%,P=0.001),两者联合对NMIBC诊断的灵敏度、特异度和准确度达90.9%,90.5%及90.8%。结论:TRUS有助于膀胱三角区、侧壁、底壁及≤5 mm膀胱恶性病变的检出,联合TR-CEUS能进一步提升对NMIBC的鉴别诊断及分期评估效能。

Objective:To investigate the role of transrectal ultrasound(TRUS)and transrectal contrast-enhanced ultrasound(TRCEUS)in diagnosing non-muscle-invasive bladder cancer(NMIBC)and make comparison with transabdominal ultrasound(TAUS).Methods:This was a retrospective study and the hospitalized patients suspicious for bladder lesions between December 2019 and February 2021 were enrolled.Before the transurethral resection surgery,ultrasound examinations including TAUS,TRUS,and TRCEUS were performed.The cystoscopy examination and pathological results after surgical resection were taken as gold standard.Results:According to the inclusion criteria,a total of 65 lesions from 43 patients were finally enrolled,including 44 malignant lesions(stage Ta-T1 bladder cancer)and 21 benign lesions.The maximum diameter of lesions between benign and malignant groups was not statistically different[5(5,13)mm vs 8(5,12)mm].TRUS detected more NMIBC than TAUS(90.9%vs 68.2%,P=0.008),especially for the lesions in diameter≤5 mm(P=0.008).In comparison with TAUS,TRUS detected more NMIBC on the triangle area,lateral wall,and base wall of the bladder(P=0.010).TR-CEUS improved the accuracy of identifying the boundary between lesion and muscle layer in contrast with TRUS(92.7%vs 60.0%,P=0.001).The sensitivity,specificity and accuracy of the TRUS combining TR-CEUS in diagnosis of NMIBC were separately 90.9%,90.5%and 90.8%.Conclusion:TRUS is useful for the detection of malignant lesions on triangle area,lateral wall and base wall of the bladder,and the lesions≤5 mm.Combining TRUS with TR-CEUS could further enhance the differential diagnosis and staging assessment of NMIBC.