Teoh Jeremy Yuen-Chun, Cho Chak-Lam, Chan Ronald Cheong-Kin, Liu Kang, Zhao Hongda, Giannarini Gianluca, Enikeev Dmitry, Ng Chi-Fai, Teoh Anthony Yuen-Bun
S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Urothelial Carcinoma Working Group, European Association of Urology - Young Academic Urologists (EAU-YAU), Arnhem, Netherlands.
Front Oncol. 2023 Jun 2;13:1160463. doi: 10.3389/fonc.2023.1160463. eCollection 2023.
Conventionally, we rely on transurethral resection of bladder tumour (TURBT) for local staging of muscle-invasive bladder cancer (MIBC). However, the procedure is limited by its staging inaccuracy which may delay the definitive treatment of MIBC.
We conducted a proof-of concept study on endoscopic ultrasound (EUS)-guided biopsy of detrusor muscle in porcine bladders. Five porcine bladders were used in this experiment. Upon EUS, four layers of tissue including the mucosa (hypoechoic), submucosa (hyperechoic), detrusor muscle (hypoechoic) and serosa (hyperechoic) could be identified.
A total of 37 EUS-guided biopsies were taken from 15 sites (three sites per bladder), and the mean number of biopsies taken from each site was 2.47±0.64. Among the 37 biopsies, 30 of them (81.1%) obtained detrusor muscle in the biopsy specimen. For the per biopsy site analysis, detrusor muscle was obtained in 73.3% if only one biopsy was taken, and 100% if two or more biopsies were taken from the same biopsy site. Overall, detrusor muscle was successfully obtained from all 15 biopsy sites (100%). No bladder perforation was observed throughout all biopsy processes.
EUS-guided biopsy of the detrusor muscle could be performed during the initial cystoscopy session, thus expediting the histological diagnosis and subsequent treatment of MIBC.
传统上，我们依靠经尿道膀胱肿瘤切除术（TURBT）对肌层浸润性膀胱癌（MIBC）进行局部分期。然而，该手术受限于分期不准确，这可能会延迟MIBC的确定性治疗。
我们对猪膀胱逼尿肌进行了内镜超声（EUS）引导下活检的概念验证研究。本实验使用了5个猪膀胱。在EUS检查时，可以识别出包括黏膜（低回声）、黏膜下层（高回声）、逼尿肌（低回声）和浆膜（高回声）在内的四层组织。
共从15个部位（每个膀胱3个部位）进行了37次EUS引导下活检，每个部位活检的平均次数为2.47±0.64。在这37次活检中，有30次（81.1%）在活检标本中获取到了逼尿肌。对于每个活检部位的分析，如果只进行一次活检，获取到逼尿肌的比例为73.3%，如果从同一活检部位进行两次或更多次活检，则获取到逼尿肌的比例为100%。总体而言，在所有15个活检部位均成功获取到了逼尿肌（100%）。在所有活检过程中均未观察到膀胱穿孔。
在初次膀胱镜检查期间可进行EUS引导下的逼尿肌活检，从而加快MIBC的组织学诊断及后续治疗。
