Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York.
Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York.
J Urol. 2015 Jan;193(1):48-52. doi: 10.1016/j.juro.2014.06.068. Epub 2014 Jun 21.
Malignant voided cytology with normal endoscopic evaluation represents a diagnostic and therapeutic challenge in many patients with a history of nonmuscle invasive bladder cancer. Bladder biopsy is often advised but its efficacy is unclear. We evaluated the usefulness of bladder biopsy in patients with unexplained positive cytology and describe recurrence patterns in this unique patient subset.
From an institutional database we retrospectively identified patients with a history of nonmuscle invasive bladder cancer and surveillance cystoscopy from 2008 to 2012 who had malignant voided urine cytology but normal cystoscopy. Patients underwent systematic bladder biopsy or cystoscopic surveillance and were followed for recurrence and progression.
Of 444 patients 343 were followed with surveillance only and 101 underwent a total of 118 biopsies of normal-appearing bladder mucosa. Three biopsies (2.5%) showed carcinoma in situ and none revealed invasive carcinoma. During the median 32-month followup recurrence developed in the bladder in 194 patients (44%), in the upper tract in 24 (5%) and in the prostatic urethra in 5 (1%) while 219 (49%) had no recurrence. A previous diagnosis of upper tract urothelial carcinoma and a history of bacillus Calmette-Guérin treatment were associated with an increased recurrence risk on multivariate analysis. Recurrence rates and patterns were similar in the biopsy and surveillance groups.
Patients with malignant cytology despite normal cystoscopy have a high recurrence rate. Biopsy of normal-appearing bladder mucosa in this setting is rarely positive and does not alter the recurrence pattern.
在许多非肌肉浸润性膀胱癌病史患者中，细胞学检查为恶性但内镜检查正常，这代表了一种诊断和治疗上的挑战。通常建议进行膀胱活检，但疗效尚不清楚。我们评估了膀胱活检在细胞学检查阳性但内镜检查正常的患者中的作用，并描述了这一独特患者亚组的复发模式。
我们从一个机构数据库中回顾性地确定了 2008 年至 2012 年间患有非肌肉浸润性膀胱癌和监测性膀胱镜检查史且细胞学检查为恶性尿液但膀胱镜检查正常的患者。患者接受了系统的膀胱活检或膀胱镜监测，并随访复发和进展情况。
在 444 例患者中，343 例仅接受了监测，101 例共进行了 118 次正常外观膀胱黏膜活检。3 次活检（2.5%）显示原位癌，无浸润性癌。在中位 32 个月的随访期间，194 例（44%）患者出现膀胱复发，24 例（5%）患者出现上尿路复发，5 例（1%）患者出现前列腺尿道复发，而 219 例（49%）患者无复发。多变量分析显示，上尿路尿路上皮癌的既往诊断和卡介苗治疗史与复发风险增加相关。活检组和监测组的复发率和模式相似。
细胞学检查为恶性但膀胱镜检查正常的患者复发率较高。在这种情况下，对正常外观的膀胱黏膜进行活检很少为阳性，且不会改变复发模式。
