Fernández Gómez J M, Rodríguez Martínez J J, Escaf Barmadah S, Pérez García J, García J, Casasola Chamorro J
Servicio de Urología I, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España.
Arch Esp Urol. 2000 Nov;53(9):785-97.
To analyze the characteristics of the random biopsies of normal-appearing mucosa taken during TUR of superficial bladder tumors and to correlate them with the outcome and characteristics of the superficial tumor.
Multiple random biopsy specimens from normal-appearing areas of 300 TUR procedures for primary or recurrent superficial urothelial carcinoma were analyzed. Preoperative cytologies were obtained in most of the patients and tumor number, localization, size, stage and grade according to the WHO classification were determined. In patients with multiple tumors, the stage, size and grade of the worst tumor were utilized. Patients who showed a risk of recurrence during follow-up received intravesical therapy postTUR of the bladder. The site and characteristics of recurrence were analyzed and compared with the random biopsy findings.
In 38 superficial tumors (12.7%), significant histological changes were found in the random biopsies of normal-appearing mucosa taken during resection. A significant difference was found between patients with and without positive random biopsies only for tumor stage. Statistically significant differences were found when comparing the primary and recurrent tumors, due to the greater number of high and moderate grade tumors in the primaries. There were significant differences in regard to the positive preoperative cytologies between the patients with negative and those with positive random biopsies. No statistical correlation was found between the localization of the superficial tumor and a positive biopsy or between the latter and the site of tumor recurrence. There were 126 recurrences (42%); mean time to recurrence was 13.5 months (median 9.5 months). No significant difference was found (log-rank) for time to recurrence in patients with positive or negative random biopsies, but significant differences were found when we analyzed the number of superficial tumors and the use of intravesical therapy, but not for the type of therapy.
Multiple random biopsies permit a better categorization of the tumor and complete staging. The outcome and the decision to administer intravesical therapy following TUR of the bladder are influenced by the foregoing. The practical results of random biopsies, however, are scanty, since the prognostic significance of the histological changes found in these biopsies is not worse than that of the superficial tumor resected. There are, however, a few cases with a higher risk of recurrence and/or progression than the superficial tumor. Preoperative cytology is useful in the selection of these patients. Furthermore, since the proportion of high grade tumors is higher in primary tumors, performing multiple biopsies is mandatory in these cases if previous urine cytology is not available.
分析浅表性膀胱肿瘤经尿道切除术（TUR）期间对外观正常黏膜进行随机活检的特征，并将其与浅表肿瘤的结局和特征相关联。
分析了300例原发性或复发性浅表性尿路上皮癌TUR手术中外观正常区域的多个随机活检标本。大多数患者术前进行了细胞学检查，并根据WHO分类确定了肿瘤数量、定位、大小、分期和分级。对于多发肿瘤患者，采用最差肿瘤的分期、大小和分级。随访期间有复发风险的患者在膀胱TUR术后接受膀胱内治疗。分析复发部位和特征，并与随机活检结果进行比较。
在38例浅表肿瘤（12.7%）中，切除期间对外观正常黏膜进行的随机活检发现了显著的组织学变化。仅在肿瘤分期方面，随机活检阳性和阴性的患者之间存在显著差异。比较原发性肿瘤和复发性肿瘤时发现有统计学显著差异，因为原发性肿瘤中高级别和中级别肿瘤数量更多。随机活检阴性和阳性的患者术前细胞学阳性情况存在显著差异。浅表肿瘤的定位与活检阳性之间或后者与肿瘤复发部位之间未发现统计学相关性。有126例复发（42%）；平均复发时间为13.5个月（中位数9.5个月）。随机活检阳性或阴性的患者复发时间无显著差异（对数秩检验），但在分析浅表肿瘤数量和膀胱内治疗的使用情况时发现有显著差异，而治疗类型无差异。
多次随机活检有助于更好地对肿瘤进行分类和完整分期。膀胱TUR术后的结局和给予膀胱内治疗的决策受上述因素影响。然而，随机活检的实际结果并不充分，因为这些活检中发现的组织学变化的预后意义并不比切除的浅表肿瘤差。不过，有少数病例的复发和/或进展风险高于浅表肿瘤。术前细胞学检查有助于选择这些患者。此外，由于原发性肿瘤中高级别肿瘤的比例较高，如果之前没有尿液细胞学检查，在这些病例中进行多次活检是必要的。
