输尿管镜活检可协助上尿路尿路上皮癌危险分层

发布时间：2018-04-02 12:16

本文选题：尿路上皮癌　切入点：输尿管镜检查　出处：《北京大学学报(医学版)》2017年04期

【摘要】：目的:分析输尿管镜活检对上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者肿瘤级别、肌层浸润以及多灶性诊断的准确性,分析术后肿瘤级别及肌层浸润的相关因素,探讨输尿管镜活检对UTUC患者术前危险分层的可行性与必要性。方法:回顾性分析北京大学第三医院泌尿外科2014年1月至2016年12月间输尿管镜活检后行肾、输尿管全长及膀胱输尿管口袖状切除术患者的临床资料。结果:患者76例,男性31例(40.8%)、女性45例(59.2%),平均年龄64.5岁(31~88岁)。肿瘤位于左侧35例、右侧41例,肾盂39例、输尿管37例,症状为肉眼血尿者51例。术后病理提示低级别21例(27.6%)、高级别51例(67.1%),未确定级别4例(5.3%);非肌层浸润27例(35.5%)、肌层浸润47例(61.9%),无法确认是否浸润2例(2.6%);术后病理均为UTUC。在50名输尿管镜活检可判断肿瘤级别的患者中,活检病理对低级别尿路上皮癌诊断的敏感性、特异性和准确性分别为88.2%、69.7%和76.0%,阳性和阴性预测值分别为60.0%和92.0%。在27例活检病理可以判断是否有肌层浸润的患者中,5例活检报告为肌层浸润的UTUC患者术后病理结果均有肌层浸润,22例报告为非肌层浸润的患者术后肌层浸润和非肌层浸润各占50%,总准确性为59.3%。输尿管镜活检对于肿物多灶性诊断的准确性为61.0%。单因素分析显示,输尿管镜活检级别与术后UTUC级别相关(P=0.001),而性别、年龄、边侧、体重指数(body mass index,BMI)、血尿、术前肾小球滤过率估计值(estimated glomerular filtration rate,e GFR)、泌尿系积水、肿瘤大小、位置、多灶性及是否有蒂均与术后UTUC级别无显著相关性。输尿管镜活检病理高级别(P=0.02)、术前e GFR90 m L/(min·1.73 m~2)(P=0.025)以及病变位于肾盂(P=0.049)与肌层浸润显著相关,性别、年龄、边侧、BMI、血尿、泌尿系积水、肿瘤大小、多灶性及是否有蒂与其无显著相关性。结论:输尿管镜活检可协助对UTUC患者进行危险分层。
[Abstract]:Objective: to analyze the accuracy of ureteroscopic biopsy in the diagnosis of tumor grade, myometrium infiltration and multiple foci in upper tract urothelial carcinoma of upper urinary tract, and to analyze the related factors of tumor grade and myometrium infiltration after operation. Objective: to investigate the feasibility and necessity of ureteroscopic biopsy for the risk stratification of UTUC patients before operation. Methods: ureteroscopic biopsy was performed in urology department of Peking University third Hospital from January 2014 to December 2016. Clinical data of patients with ureteral length and bladder ureteral cuff excision. Results: 76 patients, 31 males, 40.8g, 45 females, mean age 64.5 years old, 3188 years old, were located in the left side 35 cases, the right 41 cases, the renal pelvis 39 cases, the ureter 37 cases, the tumor was located in 35 cases on the left side, 41 cases on the right side, 39 cases on the renal pelvis, and 37 cases on the ureter. The symptoms were gross hematuria in 51 cases. The pathological findings showed that 21 cases had low grade (27.661), 51 cases had high grade (67.1%), 4 cases had undetermined grade (5.3%), 27 cases had non-myometrium infiltration (35.5m), 47 cases had muscular infiltration (47 cases), it could not be confirmed whether it was infiltrating in 2 cases (2.6%), and the postoperative pathology was UTUC. Of the 50 patients with ureteroscopic biopsies who were able to determine tumor grade, Sensitivity of biopsy pathology to the diagnosis of low grade urothelial carcinoma. The specificity and accuracy were 88.2% and 76.0%, respectively. The positive and negative predictive values were 60.0% and 92.0%, respectively. In 27 patients with myometrium infiltration, 5 out of 27 patients with myometrium infiltration could be judged by biopsy. The total accuracy of myometrium infiltration and non-myometrium infiltration were 59.3% respectively. The accuracy of ureteroscopic biopsy for the diagnosis of multifocal tumor was 61.0%. Ureteroscopic biopsy grade was correlated with postoperative UTUC grade. Sex, age, side side, body mass index (BMI) mass BMIA, hematuria, estimate of preoperative glomerular filtration rate (GFR), urinary hydronephrosis, tumor size, location, etc. There was no significant correlation between multi-focus and pedicle and postoperative UTUC grade. Ureteroscopic biopsy with high grade P0. 02, preoperative e GFR90 m L/(min 1. 73 mP0. 025) and lesion located in renal pelvis P0. 049) were significantly correlated with myometrium infiltration, sex, age, side side, hematuria, sex, age, side of ureteroscopic biopsy, and hematuria. There was no significant correlation between urological hydronephrosis, tumor size, multi-focus and pedicle. Conclusion: ureteroscopic biopsy can assist in the risk stratification of UTUC patients.
【作者单位】：北京大学第三医院泌尿外科;北京大学第三医院病理科;
【分类号】：R737.1

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