Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Department of Urology and Urologic Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Adv Ther. 2021 Jan;38(1):258-267. doi: 10.1007/s12325-020-01529-1. Epub 2020 Oct 22.
For risk stratification of non-muscle invasive bladder cancer (NMIBC), the depth of stromal invasion can be further classified, where the lamina muscularis mucosae (MM) serves as a reference structure. While the overall identifiability of MM in standard transurethral specimens is low, en bloc resection may help in identification and overall orientation. The aims of this study were to report the detection rate of MM in en bloc resected bladder tumors (ERBT) and to provide real-world information on tissue stability and preservation of en bloc architecture during recovery and processing for histopathologic evaluation.
Thirty-four ERBT specimens were histologically re-evaluated with regard to MM detectability and structure as well as the presence of en bloc architecture and further histologic features. Associations with tumor size and energy source and within histologic parameters were assessed by standard Pearson's chi-squared analyses and Cramér's V effect size testing (V).
The first parameter assessed was MM detection rate. In 19 out of 34 samples (56%) MM was detectable: scattered in 9 cases (26%), interrupted in 8 cases (24%) and continuous in 2 cases (6%). The second parameter assessed was preservation of en bloc architecture. In 11 out of 34 samples (32%), en bloc architecture could not be confirmed, and these samples served as a reference group for the detection of MM. Preservation of en bloc architecture was associated with an increased MM detection rate (MM in en bloc preserved 16/23, 70% vs. non-preserved 3/11, 27%; p = 0.020; V = 0.398) and with tumor size (p = 0.005; V = 0.595). Medium-sized tumors (1.1-2 cm) were best preserved. The choice of energy source did not show relevant association with en bloc architecture (p = n.s.).
In line with recent publications, ERBT increases the MM detection rate considerably. However, a third of the ERBT specimens lost en bloc architecture during sample recovery and processing. Tumor size is a relevant factor, with optimal architecture preservation between 1 and 2 cm. Optimizing resection techniques, recovery, transport, and diagnostic processing of ERBT samples is warranted to verify the diagnostic value of MM-based substaging.
为了对非肌肉浸润性膀胱癌（NMIBC）进行风险分层，可以进一步对间质浸润深度进行分类，其中黏膜肌层（MM）作为参考结构。虽然标准经尿道标本中 MM 的整体可识别性较低，但整块切除可能有助于识别和整体定向。本研究的目的是报告整块切除的膀胱肿瘤（ERBT）中 MM 的检出率，并提供关于组织稳定性和整块结构保存的真实信息，以恢复和处理用于组织病理学评估。
对 34 例 ERBT 标本进行组织学重新评估，评估 MM 的可检测性和结构以及整块结构的存在情况和进一步的组织学特征。使用标准 Pearson's chi-squared 分析和 Cramér 的 V 效应大小检验（V）评估与肿瘤大小和能量源以及组织学参数之间的关联。
评估的第一个参数是 MM 的检出率。在 34 个样本中的 19 个（56%）中可检测到 MM：9 例（26%）呈散在分布，8 例（24%）呈间断分布，2 例（6%）呈连续分布。评估的第二个参数是整块结构的保存情况。在 34 个样本中的 11 个（32%）中，无法确认整块结构，这些样本作为检测 MM 的参考组。整块结构的保存与 MM 检出率的增加相关（整块保存的 16/23，70%与未保存的 3/11，27%；p=0.020；V=0.398），并且与肿瘤大小相关（p=0.005；V=0.595）。中等大小的肿瘤（1.1-2cm）保存最好。能量源的选择与整块结构没有相关性（p=n.s.）。
与最近的出版物一致，ERBT 大大提高了 MM 的检出率。然而，三分之一的 ERBT 标本在样本回收和处理过程中失去了整块结构。肿瘤大小是一个相关因素，1-2cm 之间最佳的结构保存。优化 ERBT 标本的切除技术、回收、运输和诊断处理是验证基于 MM 的亚分期诊断价值的必要条件。
