Pagliarulo Vincenzo, Alba Stefano, Gallone Maria Filomena, Di Stasi Savino, Cormio Luigi, Petitti Tommasangelo, Buscarini Maurizio, Minafra Paolo, Carrieri Giuseppe
1 Urology and Andrology Unit, Department of Emergency and Organ Transplantation, University Aldo Moro , Bari, Italy .
2 Department of Urology and Mini-Invasive Surgery, Romolo Hospital , Crotone, Italy .
J Endourol. 2017 Apr;31(4):405-411. doi: 10.1089/end.2016.0804. Epub 2017 Mar 1.
To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer.
A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, and biopsy samples from normal appearing mucosa, were all recorded separately.
Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of carcinoma in situ (CIS). The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%).
Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.
比较白光膀胱镜检查（WLC）和蓝光膀胱镜检查（BLC）在一组因先前切除的尿路上皮膀胱癌而接受根治性膀胱切除术（RC）的患者中的准确性。
一组接受RC的患者在根治性手术前接受了WLC和BLC检查。为评估残留肿瘤率，在切除膀胱后对其进行检查，并对外观正常的黏膜进行取样以进行组织学分析。在WLC、BLC或两者检查下发现的病变，以及外观正常黏膜的活检样本，均分别记录。
从2011年开始，64例患者在膀胱切除术前行WLC和BLC检查。总体而言，膀胱镜检查期间及外观正常黏膜共采集了540份组织样本。在31/64（48.4%）例患者中发现残留疾病，其中包括27例（42.1%）原位癌（CIS）。BLC的准确性远高于WLC，在诊断任何残留疾病方面（敏感性分别为87.1%对32.3%，特异性分别为87.9%对51.5%），仅对于CIS（敏感性分别为92.6%对29.6%，特异性分别为83.8%对51.4%）。我们通过对研究期间采集的所有标本进行分析进一步评估了诊断准确性。共分析了535份标本，发现58份有残留疾病的标本，其中包括48个CIS病灶。同样，BLC的检出率和准确性指标在总体上（敏感性分别为86.2%对31%，特异性分别为98.3%对93.3%）以及仅考虑CIS时（敏感性分别为89.6%对31.2%，特异性分别为96.9%对92.8%）均远优于WLC。
尽管BLC漏诊了12.9%的阳性患者以及7.4%患有CIS 的患者，但BLC诊断准确性与最终病理结果之间的一致性非常强。
