Hermann Gregers G, Mogensen Karin, Toft Birgitte Grønkær, Glenthøj Anders, Pedersen Helle M
Department of Urology, Copenhagen University, Frederiksberg Hospital, Copenhagen, Denmark.
Scand J Urol Nephrol. 2012 Feb;46(1):31-6. doi: 10.3109/00365599.2011.637954. Epub 2011 Dec 12.
The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD).
Seventy-three patients (aged 36-91 years) with recurrent non-muscle-invasive bladder cancer and a medium to high risk of recurrence had a flexible PDD cystoscopy performed in the OPD. The bladder was first examined in standard white light followed by PDD.
PDD was superior to white light diagnosis; PDD was positive in 16 patients (22%) where white light showed a normal bladder mucosa. Four of these patients had bladder tumour [4/73, 6%; two carcinoma in situ (CIS), two Ta]. The diagnosis was verified by transurethral resection of the bladder tumour in the operating room. In 20 patients (20/73, 27%) PDD identified additional tumour lesions that were not identified in white light (five CIS, 15 Ta). The false-positive detection rate of PDD was 0.41. False positivity was significantly reduced by simultaneous flex biopsies disproving malignancy. Biopsies were obtained from 57 patients and diagnosis of stage and grade were possible in 55 of these (97%). In two patients (4%) the tissue material was too small for diagnostic evaluation. Biopsies from 47 patients (83%) included muscularis mucosa and from 20 patients (35%) muscularis propria. In 30 patients all but one diagnosis from the OPD was confirmed by biopsy in rigid scopes in the operating room.
PDD-guided cystoscopy and bladder biopsy in flexible cystoscopes can be performed in an OPD setting and with reliable results for diagnosis of tumour stage Ta, CIS and T1a bladder cancer.
本研究旨在评估柔性膀胱镜检查中的光动力诊断（PDD）以及门诊（OPD）中非肌层浸润性膀胱癌活检的诊断质量。
73例（年龄36 - 91岁）复发性非肌层浸润性膀胱癌且复发风险为中到高的患者在门诊接受了柔性PDD膀胱镜检查。首先在标准白光下检查膀胱，随后进行PDD检查。
PDD优于白光诊断；在白光显示膀胱黏膜正常的16例患者（22%）中，PDD呈阳性。其中4例患者患有膀胱肿瘤[4/73，6%；2例原位癌（CIS），2例Ta期]。通过在手术室经尿道切除膀胱肿瘤证实了诊断。在20例患者（20/73，27%）中，PDD发现了白光未发现的额外肿瘤病变（5例CIS，15例Ta）。PDD的假阳性检出率为0.41。通过同时进行柔性活检排除恶性肿瘤，假阳性率显著降低。对57例患者进行了活检，其中55例（97%）能够诊断分期和分级。2例患者（4%）的组织材料过小无法进行诊断评估。47例患者（83%）的活检包含黏膜肌层，20例患者（35%）的活检包含固有肌层。在30例患者中，门诊的所有诊断（除1例）均在手术室通过硬镜活检得到证实。
在门诊环境中可以进行PDD引导的柔性膀胱镜检查及膀胱活检，对于Ta期、CIS期和T1a期膀胱癌的诊断结果可靠。
