前瞻性评估六亚甲基蓝在非肌层浸润性膀胱癌的蓝激光膀胱软镜检查中的应用。
Prospective evaluation of blue-light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer.
机构信息
Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, University of Southern California, Los Angeles, CA, USA.
出版信息
BJU Int. 2021 Jan;127(1):108-113. doi: 10.1111/bju.15166. Epub 2020 Aug 6.
OBJECTIVES
To evaluate the utility of blue-light flexible cystoscopy (BLFC) for surveillance of non-muscle-invasive bladder cancer (NMIBC).
PATIENTS AND METHODS
Prospective cohort of consecutive patients who underwent office-based BLFC for NMIBC. Clinical information was collected including cystoscopic findings and pathological data.
RESULTS
A total of 322 cases were performed on 190 patients. The mean age was 71 years and 83% were men. The highest stage prior to BLFC was Ta, carcinoma in situ (CIS), T1, and T2 in 45.3%, 18.4%, 30% and 2%, respectively. Prior to BLFC, 16.8%, 60.5%, and 16.8% were low grade (LG), high grade (HG), and CIS, respectively. Intravesical bacille Calmette-Guérin and intravesical chemotherapy were used in 54.2% and 18.4%, respectively. White-light cystoscopy (WLC) and BLFC were both normal in 173 (53.7%) of cases. WLC was normal and BLFC was abnormal in 26 (8%) cases. Of these, 15 had office-based biopsy and cancer was detected in 13 (87%; six CIS, four HG Ta, three LG Ta). Both WLC and BLFC were positive in 83 (25.8%) cases and 33% had additional tumours found. Cancer was found in 27 (75%) of WLC+/BLFC+ who underwent office-based biopsy including 19 LG Ta, six HG Ta, and two CIS.
CONCLUSIONS
Incorporation of BLFC in clinical practice has potential advantages of finding cancer in cases with normal WLC. BLFC detected additional cancers in 33% of patients with positive WLC and BLFC, which can improve surveillance and performance of office-based biopsy. Further research is needed to determine cost-effectiveness and impact on recurrence rates.
目的
评估蓝激光膀胱软镜（BLFC）在非肌层浸润性膀胱癌（NMIBC）监测中的应用价值。
方法
对连续接受 BLFC 检查的 NMIBC 患者进行前瞻性队列研究。收集临床信息，包括膀胱镜检查结果和病理数据。
结果
共对 190 例患者的 322 例病例进行了检查。患者的平均年龄为 71 岁，83%为男性。BLFC 前最高分期为 Ta、原位癌（CIS）、T1 和 T2，分别占 45.3%、18.4%、30%和 2%。BLFC 前低级别（LG）、高级别（HG）和 CIS 分别占 16.8%、60.5%和 16.8%。54.2%的患者接受了膀胱内卡介苗和膀胱内化疗，18.4%的患者接受了膀胱内化疗。173 例（53.7%）患者的白光膀胱镜（WLC）和 BLFC 均正常。26 例（8%）患者 WLC 正常而 BLFC 异常，其中 15 例行门诊活检，13 例（87%；6 例 CIS、4 例 HG Ta、3 例 LG Ta）发现了癌症。83 例（25.8%）患者的 WLC 和 BLFC 均为阳性，其中 33%发现了额外的肿瘤。27 例（75%）WLC+/BLFC+患者接受了门诊活检，其中包括 19 例 LG Ta、6 例 HG Ta 和 2 例 CIS。
结论
在临床实践中纳入 BLFC 具有在 WLC 正常的情况下发现癌症的潜在优势。BLFC 检测到 WLC 和 BLFC 阳性的患者中有 33%存在额外的癌症，这可以提高门诊活检的监测和性能。需要进一步研究来确定其成本效益和对复发率的影响。
Zotero 插件