关于“经尿道膀胱卡介苗灌注治疗非肌肉浸润性膀胱癌后膀胱活检的价值：回顾性单中心研究和文献累积分析。” Swietek N, Waldert M, Rom M, Schatzl G, Wiener HG, Susani M, Klatte T. 维也纳医科大学泌尿外科，维也纳，奥地利：J Urol 2012;188(3):748-53 [Epub 2012 Jul 20]。

Commentary on "The value of transurethral bladder biopsy after intravesical bacillus Calmette-Guérin instillation therapy for nonmuscle invasive bladder cancer: a retrospective, single center study and cumulative analysis of the literature." Swietek N, Waldert M, Rom M, Schatzl G, Wiener HG, Susani M, Klatte T. Department of Urology, Medical University of Vienna, Vienna, Austria: J Urol 2012;188(3):748-53 [Epub 2012 Jul 20].

出版信息

Urol Oncol. 2013 Jul;31(5):715-6. doi: 10.1016/j.urolonc.2013.03.014.

DOI:10.1016/j.urolonc.2013.03.014

Abstract

PURPOSE

We evaluated the need of routine transurethral biopsies after an induction course of intravesical bacillus Calmette-Guérin for high grade nonmuscle invasive bladder cancer.

MATERIALS AND METHODS

This retrospective study included 180 patients with high grade nonmuscle invasive bladder cancer who underwent a 6-week induction course of bacillus Calmette-Guérin. Cystoscopic findings, urinary cytology and pathological results of transurethral biopsy were evaluated. For cumulative meta-analysis we systematically reviewed studies indexed in MEDLINE(®), EMBASE(®) and Web of Science(®). The records of 740 patients from a total of 7 studies were finally analyzed.

RESULTS

Biopsy was positive in 58 patients (32%). Cystoscopy appeared normal in 75 patients (42%) and showed only erythema in 51 (28%) and tumor in 54 (30%), of whom 6 (8%), 11 (22%) and 41 (76%), respectively, showed positive findings at biopsy. The positive predictive value of erythema was 15% with negative cytology and 56% with positive cytology. The positive predictive value of a tumor with negative and positive cytology was 63% and 89%, respectively. A combination of negative cytology and normal cystoscopy was associated with a negative biopsy in 94% of cases. A total of 970 bladder biopsies were taken, of which 137 (14%) were positive, including 20 of 125 erythematous lesions (16%), 73 of 107 tumors (68%) and 44 of 738 normal-appearing areas (6%). Cumulative analysis findings were comparable.

CONCLUSIONS

Routine transurethral bladder biopsies after a bacillus Calmette-Guérin induction course are not necessary. An individually approach is recommended, tailored from cystoscopic findings and cytology.

摘要

目的

我们评估了在卡介苗膀胱内诱导治疗后是否需要常规经尿道活检高分级非肌层浸润性膀胱癌。

材料与方法

本回顾性研究纳入了 180 例高分级非肌层浸润性膀胱癌患者，他们接受了 6 周的卡介苗诱导治疗。评估了膀胱镜检查结果、尿细胞学和经尿道活检的病理结果。为了进行累积荟萃分析，我们系统地检索了 MEDLINE(®)、EMBASE(®)和 Web of Science(®) 中的研究。最终分析了来自 7 项研究的 740 例患者的记录。

结果

活检阳性 58 例（32%）。75 例（42%）膀胱镜检查正常，51 例（28%）仅表现为红斑，54 例（30%）表现为肿瘤，其中活检阳性的分别为 6 例（8%）、11 例（22%）和 41 例（76%）。细胞学阴性和阳性时红斑的阳性预测值分别为 15%和 56%。细胞学阴性和阳性时肿瘤的阳性预测值分别为 63%和 89%。细胞学阴性和膀胱镜检查正常的组合在 94%的病例中与活检阴性相关。共进行了 970 例膀胱活检，其中 137 例（14%）为阳性，包括 125 例红斑病变中的 20 例（16%）、107 例肿瘤中的 73 例（68%）和 738 例正常外观区域中的 44 例（6%）。累积分析结果相当。