Abdel-Razzak O M, Ehya H, Cubler-Goodman A, Bagley D H
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Urology. 1994 Sep;44(3):451-7. doi: 10.1016/s0090-4295(94)80116-9.
To determine the optimal instruments and techniques for biopsy of upper urinary tract lesions through the small working channel in flexible and small semirigid ureteroscopes.
Urinary tract filling defects and other lesions were accessed with rigid or flexible ureteroscopy and biopsies were done using one or more devices: a 3 F cup biopsy forceps, 2.5 F and 3 F baskets, 2.5 F and 3 F graspers, 3 F snare, brush, and aspiration catheters. All samples, including the cup forceps samples, were sent for cytopathologic study, with those containing grossly visible tissue particles processed as a cell block. Only those specimens reported definitely positive or negative were considered diagnostic, whereas the others were grouped as nondefinitive. Not all sampling techniques could be used in every patient because of the size of the lesion and the technical limitations, including bleeding and instrument position during biopsy.
There were 55 procedures in 43 patients. The indications included hematuria, filling defect, abnormal cytology, and periodic surveillance. A basket was used in 22 procedures and gave unequivocal results in 15. The other samples were equivocal, nondiagnostic, or unsuitable. The biopsy forceps provided a definitive result in 16 of 21 samples and the grasper was definitive in 5 of 6 samples. We could not obtain a suitable specimen using a snare in 2 cases and the brush gave a definitive result in only 5 of 11 cases. Samples of aspirate and washings were definitive in less than 50% of instances but detected some tumors for which other techniques were equivocal.
For the best results, the largest biopsy specimen possible should be obtained. Aspiration or wash alone is often not diagnostic but can give a diagnosis in some patients. Tissue sampling devices, such as the forceps and basket, have an advantage in obtaining a larger sample. Cytopathologic techniques are particularly useful for handling and interpreting the small specimens obtained with ureteroscopic biopsy techniques.
确定通过可弯曲及小型半硬性输尿管镜的小工作通道对上尿路病变进行活检的最佳器械和技术。
采用硬性或可弯曲输尿管镜检查尿路充盈缺损及其他病变，并使用一种或多种器械进行活检：3F杯状活检钳、2.5F和3F篮式活检钳、2.5F和3F抓取钳、3F圈套器、刷子及抽吸导管。所有样本，包括杯状活检钳获取的样本，均送去做细胞病理学研究，其中含有肉眼可见组织颗粒的样本制成细胞块。只有那些报告为明确阳性或阴性的标本才被视为具有诊断价值，其他则归为不明确。由于病变大小及技术限制，包括活检时出血和器械位置等因素，并非所有采样技术都能用于每位患者。
43例患者共进行了55次操作。适应证包括血尿、充盈缺损、细胞学异常及定期监测。22次操作中使用了篮式活检钳，15次得到明确结果。其他样本结果不明确、无诊断价值或不适用。活检钳在21个样本中的16个给出了明确结果，抓取钳在6个样本中的5个给出了明确结果。2例使用圈套器未能获取合适标本，刷子在11例中仅5例给出明确结果。抽吸和冲洗样本在不到50%的情况下具有诊断价值，但能检测出一些其他技术结果不明确的肿瘤。
为获得最佳结果，应获取尽可能大的活检标本。单独抽吸或冲洗往往无法诊断，但在某些患者中可得出诊断。组织采样器械，如活检钳和篮式活检钳，在获取较大样本方面具有优势。细胞病理学技术对于处理和解读通过输尿管镜活检技术获取的小标本特别有用。
