Yang Yongjun, Liu Chao, Yan Xiaoting, Li Jiawei, Yang Xiaofeng
First Clinical Medical College, Shanxi Medical University, Taiyuan, China.
Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China.
Front Oncol. 2021 Mar 16;11:638083. doi: 10.3389/fonc.2021.638083. eCollection 2021.
Although transurethral resection of bladder tumor is the golden standard for the treatment of non-muscle invasive bladder cancer, this surgical procedure still has some serious drawbacks. For example, piecemeal resection of tumor tissue results in exfoliated tumor cells dissemination and implantation, and fragmented tumor specimens make it difficult for pathologists to accurately assess the pathological stage and histologic grade. En bloc tumor resection follows the basic principle of oncological surgery and provides an intact tumor specimen containing detrusor muscle for pathologists to make accurate histopathological assessment. However, there is no robust clinical evidence that en bloc tumor resection is superior to conventional resection in terms of oncological outcomes. Considering the high recurrence rate, small or occult tumor lesions may be overlooked and incomplete tumor resection may occur during white light cystoscopy-assisted transurethral resection. Molecular fluorescent tracers have the ability to bind tumor cells with high sensitivity and specificity. Optical molecular imaging mediated by it can detect small or occult malignant lesions while minimizing the occurrence of false-positive results. Meanwhile, optical molecular imaging can provide dynamic and real-time image guidance in the surgical procedure, which helps urologists to accurately determine the boundary and depth of tumor invasion, so as to perform complete and high-quality transurethral tumor resection. Integrating the advantages of these two technologies, optical molecular imaging-assisted en bloc tumor resection shows the potential to improve the positive detection rate of small or occult tumor lesions and the quality of transurethral resection, resulting in high recurrence-free and progression-free survival rates.
尽管经尿道膀胱肿瘤切除术是治疗非肌层浸润性膀胱癌的金标准，但该手术仍存在一些严重缺点。例如，肿瘤组织的碎块切除会导致脱落的肿瘤细胞播散和种植，且破碎的肿瘤标本使病理学家难以准确评估病理分期和组织学分级。整块肿瘤切除遵循肿瘤外科的基本原则，并为病理学家提供包含逼尿肌的完整肿瘤标本，以便进行准确的组织病理学评估。然而，尚无有力的临床证据表明整块肿瘤切除在肿瘤学结局方面优于传统切除。考虑到高复发率，在白光膀胱镜辅助经尿道切除术中，小的或隐匿的肿瘤病灶可能被忽视，并且可能发生肿瘤切除不完全的情况。分子荧光示踪剂具有以高灵敏度和特异性结合肿瘤细胞的能力。由其介导的光学分子成像能够检测小的或隐匿的恶性病灶，同时将假阳性结果的发生降至最低。与此同时，光学分子成像可在手术过程中提供动态实时图像引导，这有助于泌尿外科医生准确确定肿瘤浸润的边界和深度，从而进行完整且高质量的经尿道肿瘤切除。结合这两种技术的优势，光学分子成像辅助整块肿瘤切除显示出提高小的或隐匿肿瘤病灶的阳性检出率以及经尿道切除质量的潜力，从而实现高无复发生存率和无进展生存率。
