窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.     

NBI技术结合电子软膀胱镜在膀胱肿瘤早期诊断中的应用研究

目的：评估窄带成像（NBI）技术结合电子软膀胱镜（简称NBI膀胱镜）在膀胱肿瘤早期诊断中的应用价值。方法：2009年1月～5月对85例早期膀胱肿瘤或癌前病变患者,首先使用标准白光（WLI）膀胱镜进行观察,接着使用NBI膀胱镜进行观察,均记录观察到的乳头状肿瘤个数,最后取活组织检查并进行病理学诊断。对比NBI膀胱镜与WLI膀胱镜在膀胱肿瘤早期诊断中的检出率。结果：NBI技术能够提供更加清晰的膀胱肿瘤的图像,特别是肿瘤组织与正常膀胱黏膜的边界。85例中包括乳头状Ta期膀胱肿瘤76例,原位癌6例,重度不典型增生3例。使用WLI膀胱镜：Ta期膀胱肿瘤76例检查出肿瘤个数为178,原位癌检查出2例,重度不典型增生检查出1例;使用NBI膀胱镜：Ta期膀胱肿瘤76例检查出肿瘤个数214,原位癌检查出6例,重度不典型增生检查出3例;检出率分别提高了20．2％,200％,200％。结论：与WLI膀胱镜相比,NBI膀胱镜的应用能更清晰的显示肿瘤组织与正常膀胱黏膜的边界,提高早期膀胱癌及癌前病变的诊出率,降低漏诊率。     

窄光成像膀胱镜在膀胱肿瘤诊断中的应用

目的 探讨窄光成像诱导光动力学检查对膀胱肿瘤早期诊断的应用价值. 方法 应用高清窄光成像膀胱镜系统对28例血尿患者进行膀胱镜检,术中分别对普通光下及窄光下的可疑部位膀胱黏膜组织活检,普通光组取样35处,窄光组取样79处(含普通光35处,普通光镜下疑似者窄光均显示镜下疑似,不重复取样)送病理检查.比较窄光取样组和普通光取样组肿瘤检出敏感性.结果 窄光取样组活检病理报告尿路上皮癌32处(21例),其中原位癌11处,腺性膀胱炎5处(2例),良性病变(炎性病变)3处(2例),正常黏膜4处(3例).普通光取样组尿路上皮癌17处(15例),腺性膀胱炎2处(1例),无原位癌.活检病理阳性32处,窄光组病理阳性32处,肿瘤检出率100%(32/32);普通光组病理阳性17处.肿瘤检出率53%(17/32);膀胱肿瘤及原位癌检出率2组比较差异有统计学意义(P<0.01).共取样79处,其中窄光组阳性32处,敏感性41%(32/79);普通光组阳性17处,敏感性22%(17/79),2组肿瘤取样敏感性比较差异有统计学意义(P<0.01). 结论 窄光成像膀胱镜能提高对膀胱肿瘤特别是原位癌的诊断敏感性,降低术中残存率,减少膀胱肿瘤复发危险性.     

二氧化碳气膀胱镜技术在膀胱肿瘤诊断中的应用

目的探讨CO2气膀胱镜技术在诊断膀胱肿瘤中的应用价值。方法以CO2气体为介质,采用气膀胱镜技术,对50例膀胱肿瘤患者进行检查,观察其对呼吸、循环系统及上尿路系统的影响并评价其安全性、可行性。结果操作顺利,检查时间为（21.0±8.2）min。术中、术后无相关并发症发生。检查前、开始5min、10min及结束后30min的血压、心率、血氧饱和度值相比,无统计学差异（P〉0.05）。检查前、后血气分析中pH值、CO2分压值、O2分压值相比无统计学差异（P〉0.05）。检查前、后肾盂及输尿管上段宽度无统计学差异（P〉0.05）。结论 CO2气膀胱镜技术对机体呼吸、循环系统及上尿路系统无明显影响,安全有效;对膀胱肿瘤合并有血尿的患者,相对于传统膀胱镜技术而言更具有优势。     

螺旋CT仿真膀胱镜在膀胱肿瘤诊断中的应用

目的：探讨螺旋CT仿真膀胱镜（CTVC）在膀胱肿瘤诊断中的应用和临床价值。方法：使用GE Hispeed CT/i螺旋CT扫描机对38例可疑膀胱肿瘤患者行平扫，增强扫描后再延迟扫描（层厚3－5mm)，螺距1．5mm，重建率60．0％－66．6％，并利用GE AW3．1工作站Navigator软件生成仿真内窥镜影像。结果：CTVC检查的准确度为94．4％，特异度为99．9％，敏感度为96．0％，CTVC对病变形态的显示与纤维膀胱镜和标本具有良好的对应性，结论：CTVC是一种新的非侵袭检查手段，有一定的临床使用价值。     

膀胱软镜在泌尿系疾病中应用进展

膀胱软镜具有细小、柔软、弯曲的镜体和广角清晰的图像,在泌尿系疾病的治疗中具有很大的前景。通过对膀胱软镜的结构和功能的阐述,展现了膀胱软镜相比膀胱硬镜的优势,在泌尿系结石的治疗中体现了膀胱软镜能够辅助完成取石手术,并取得良好的清石率。在早期膀胱肿瘤的诊断与治疗中,结合窄带和荧光成像技术,提高了早期膀胱肿瘤的检出率和降低了术后的复发率。在男性尿道狭窄或断裂情况下,膀胱软镜的检查和治疗具有独特的优势,辅助腹膜外腹腔镜下肌层膀胱癌的部分切除具有重大的临床价值。阐述了膀胱软镜在临床上应用的优势,也提出了相关的不足,展望了膀胱软镜的相关日间手术模式会走向成熟的阶段。     

CT三维成像在膀胱肿瘤诊断中的应用价值

目的：探讨CT三维重建成像技术（3D-CT）在膀胱肿瘤诊治中的应用价值。方法：应用3D-CT对15例膀胱占位病变的患者进行检查，对诊断和分期结果与术后病理进行对比分析。结果：3D-CT诊断膀胱癌12例（移行细胞癌），膀胱良性肿瘤2例（平滑肌瘤），肠道肿瘤侵及膀胱1你（结肠癌），3D-CT诊断定位准确率100％。12例膀胱癌术前分期：T15例，T23例，T33例，T41例，与病理分期对照，准确率83％（10/12）。结论：3D-CT可以提高膀胱术前分期准确性，对手术选择具有重要的参考价值。     

电子膀胱软镜在男性患者门诊手术中的应用

目的探讨电子膀胱软镜在男性患者门诊手术中的应用价值。方法总结2007年1月至2008年6月采用电子膀胱软镜检查的107例门诊患者及同期行膀胱硬镜检查的203例患者的资料。结果软镜组患者均顺利完成软镜操作，平均手术时间4．3（3～12）min，术中疼痛评分平均0．7（0～2）分，仅5例术中行活检的患者术后24h内出现淡红色肉眼血尿，7例患者术后24h内有轻微的排尿灼热感。硬镜组平均手术时间4．6（3～16）min，术中疼痛评分平均4．6（2～8）分，3例术前超声提示膀胱占位的患者因膀胱颈口抬高明显未检出改行软镜检查，3例出现术后尿潴留并予留置导尿，17例术后72h持续肉眼血尿，6例术后出现尿频、尿急、尿痛等严重尿路刺激症状。两组疼痛评分、并发症发生率均有显著差异P〈0．05。结论电子膀胱软镜具有痛苦小，无盲区，并发症少，适合特殊患者检查等优点，可作为门诊膀胱镜检的男性患者，特别是有排尿困难病史的老年男性的首选方法。     

膀胱充气CT仿内窥镜成像技术在膀胱肿瘤诊断中的价值

20 0 0年4月至2 0 0 2年4月,我们对2 4例膀胱肿瘤患者行膀胱注气CT仿内窥镜检查,诊断效果好,现报告如下。材料与方法　本组2 4例。男2 1例,女3例。年龄5 1～76岁,平均6 1岁。临床表现无痛性肉眼血尿2 0例,排尿困难4例。2 0例行B超检查诊断为膀胱肿瘤。膀胱镜检查诊断膀胱肿瘤2 1例,无异常发现3例。患者取平卧位,置Foley导尿管,排空膀胱,气囊内注水5ml,经导管向膀胱内注入气体约5 0 0ml,夹闭Foley管。采用PickerPQ6 0 0 0螺旋CTVoxilQ计算机工作站,Version3.3.2～3.4 .3软件,对膀胱进行定位,行膀胱容积扫描,重建原始二维图像80～12 0层…     

Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder

OBJECTIVE

To investigate whether narrow‐band imaging (NBI) flexible cystoscopy improves the detection rate of urothelial carcinomas (UCs) of the bladder. NBI is an optical image enhancement technology in which the narrow bandwidth of light is strongly absorbed by haemoglobin and penetrates only the surface of tissue, increasing the visibility of capillaries and other delicate tissue surface structures by enhancing contrast between the two.

PATIENTS AND METHODS

Between November 2005 and May 2007 at the Queen Elizabeth Hospital, Birmingham, NBI flexible cystoscopy was performed on 29 patients with known recurrences of UC of the bladder after initial conventional white‐light imaging (WLI) flexible cystoscopy with the same instrument (Olympus Lucera sequential RGB endoscopy system).

RESULTS

Subjectively, NBI provided a much clearer view of bladder UCs and in particular their delicate capillary architecture. Objectively, NBI detected 15 additional UCs in 12 of 29 patients (41%), as compared with WLI. The mean (sd ) difference was 0.52 (0.74) UCs per patient (P < 0.001, Wilcoxon signed‐rank test).

CONCLUSIONS

Even in the few patients studied there is strong evidence that NBI differs from WLI in the number of UCs it detects, with a significantly increased detection rate. We feel that further evaluation of NBI flexible cystoscopy in more patients will show this technique to be highly valuable in the detection of both new and recurrent bladder UCs, and this work is continuing in our unit.     

Evaluation of an orthotopic rat bladder urothelial cell carcinoma model by cystoscopy

OBJECTIVES

To enable preclinical testing of intravesical therapies against non‐muscle‐invasive bladder cancer (NMIBC) in an orthotopic rat bladder tumour model, augmented by the use of serial cystoscopy for in vivo tumour assessment and follow‐up.

MATERIALS AND METHODS

Fischer F344 rats had a 16‐G transurethral cannula placed. The bladder mucosa was conditioned with an acid rinse, followed by a 1‐h instillation of 1.5 × 10⁶ AY‐27 rat bladder urothelial cell carcinoma (UCC) cells (day 0). Cystoscopy (1 mm) was done on day 0 (control) and at 3, 4, 5, 6, 7, 10, 13 and 17 days. At the scheduled times the rats were killed after cystectomy (four at each time) for histopathological examination of the bladder.

RESULTS

Overall, tumour establishment was >80%, with predominantly carcinoma in situ preceding or concomitant with invasive tumour growth. All tumours were formed at 3–5 days, and remained non‐muscle‐invasive up to 5 days. From 6 days, tumours progressed to muscle‐invasive disease in 40% of the rats. Visibility at cystoscopy was excellent and tumours were apparent in >90% of rats from 5 days on, with a specificity and sensitivity of >90%. Cystoscopy could not distinguish NMIBC from muscle‐invasive disease.

CONCLUSIONS

This is a reliable model of orthotopic rat bladder UCC, with early high‐grade NMIBC growth, immediately followed by muscle‐invasive growth, i.e. the recommended time to start intravesical therapy would be 5 days after tumour cell inoculation. Tumour growth can easily be monitored by cystoscopy, but cannot be used to distinguish NMIBC from muscle‐invasive bladder cancer.     

门诊患者对软性膀胱镜和硬性膀胱镜的耐受性比较

目的:为进一步阐明软性膀胱镜在门诊检查中患者耐受性方面的优势。方法:132例门诊患者随机接受软性膀胱镜检查(77例)和硬性膀胱镜检查(55例),用数字分级法对患者检查前、检查中、检查后15min和3天的疼痛指数进行评估。结果:85%的软镜组患者为检查中轻微疼痛(评分为0~3),而硬镜组仅为47%(P<0.05)。检查中疼痛评分软镜组为2.3vs硬镜组3.4(P<0.05)。软镜组检查后15min疼痛评分恢复到检查前水平(0.5vs0.2),而硬镜组(2.3vs0.3)3天后才恢复到检查前水平。结论:软性膀胱镜的耐受性明显好于硬镜,更适于门诊患者的检查。     

Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy

PURPOSE: In this European multicenter study we compared hexaminolevulinate (HAL) fluorescence cystoscopy and standard white light cystoscopy for the detection of carcinoma in situ (CIS) in patients suspected of having high risk bladder cancer. MATERIALS AND METHODS: This study was a prospective controlled, within-patient comparison of standard and HAL fluorescence cystoscopy. Eligible patients received an intravesical instillation of 50 ml HAL 8 mM solution. Cystoscopy was performed using a D light system, which provided white and blue light at 375 to 440 nm. The bladder wall was inspected and mapped, first under white light, followed by blue light. All tumors and suspicious areas identified under white light and by red fluorescence were resected or biopsied. Histological findings were assessed by an independent central pathologist blinded to the identity of the biopsies. RESULTS: Of 211 evaluable patients 83 (39%) had CIS, of whom 18 (22%) were detected by HAL cystoscopy only, 62 (75%) were detected by standard and HAL cystoscopy, 2 (2%) were detected by standard cystoscopy only and 1 (1%) was detected by nonguided biopsy. Therefore, HAL cystoscopy identified 28% more patients with CIS than standard cystoscopy. The side effects of HAL instillation were negligible and no unexpected events were reported. CONCLUSIONS: HAL fluorescence cystoscopy improves the detection of bladder CIS significantly, which has consequences for clinical management and may improve the patient prognosis. The procedure is easily implemented as an adjunct to standard cystoscopy and it adds no significant risk of complications.     

The use of blue-light cystoscopy in the detection and surveillance of nonmuscle invasive bladder cancer

Nonmuscle invasive bladder cancer is associated with a high risk of recurrence as well as progression to muscle-invasive disease. Therefore, adequate visualization and identification of malignant lesions as well as complete resection are critical. Traditional white-light cystoscopy is limited in its ability to detect bladder cancer, specifically carcinoma in situ. Blue-light cystoscopy makes use of the intravesical instillation of a heme precursor to differentiate areas of malignancy from normal tissue. A narrative review of the literature on the use of blue-light cystoscopy in bladder cancer was conducted. Blue-light cystoscopy has been shown in several randomized clinical trials to increase detection of Ta, T1, and carcinoma in situ, as well as reduce risk of recurrence at 12 months as compared with traditional white-light cystoscopy. Research into the effects of blue-light cystoscopy on risk of disease progression has produced mixed results, in part due to changing definitions of progression. However, more recent research suggests a correlation with decreased risk of progression. Whereas the use of blue-light was initially limited to rigid cystoscopy in the operating room, results from a recent randomized clinical trial showing enhanced detection of recurrent disease using blue-light in-office surveillance flexible cystoscopy have led to expanded Food and Drug Administration approval. Overall, blue-light cystoscopy offers promise as an enhancement to white-light cystoscopy for the detection of nonmuscle invasive bladder cancer and may yield additional benefits in reducing disease recurrence and progression. Further prospective research is needed to evaluate the true benefit of blue-light cystoscopy in terms of disease progression as well as the cost-effectiveness of this technique.     

A comparison of white-light cystoscopy and narrow-band imaging cystoscopy to detect bladder tumour recurrences

OBJECTIVE

To determine whether narrow‐band imaging (NBI) cystoscopy enhances the detection of non‐muscle‐invasive bladder tumours over standard white‐light imaging (WLI) cystoscopy, as surveillance WLI is the standard method used to diagnose patients with recurrent bladder tumours, but they can be missed by WLI cystoscopy, possibly accounting for early recurrences.

PATIENTS AND METHODS

We evaluated 427 patients for recurrent bladder tumours by WLI cystoscopy, followed by NBI cystoscopy as a further procedure, using the same video‐cystoscope. Recurrent tumours visualized by WLI or NBI cystoscopy were mapped, imaged, biopsied and subsequently treated by transurethral resection (TUR) or fulguration. Biopsies or TUR specimens obtained by WLI and NBI were examined separately for presence of tumour.

RESULTS

In all, 103 patients (24%) had tumour recurrences; 90 (87%) were detected by both WLI and NBI and another 13 (100%) only by NBI cystoscopy. NBI detected extra papillary tumours or more extensive carcinoma in situ in 58 (56%) patients found to have recurrences. The mean number of recurrent tumours visualized on WLI cystoscopy was 2.3, vs to 3.4 seen on NBI cystoscopy (P = 0.01).

CONCLUSION

NBI cystoscopy improved the detection of recurrent non‐muscle‐invasive bladder tumours over standard WLI cystoscopy.