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目的探讨膀胱癌术前膀胱镜活检低估病理分级现象的可能原因,为治疗方案选择提供更可靠的依据。方法采用WHO/ISUP 1998病理分级标准,对82例术前膀胱镜活检诊断为膀胱癌、术后病理检查资料完整的患者分级情况进行对比分析。结果82例术前活检标本病理分级为G_1 35例、G_2 28例、G_3 19例,术后标本为G_1 22例、G_2 32例、G_3 28例。活检标本与术后标本病理分级一致54例(65．8%),活检低分级24例(29．3%),高分级4例(4．9%)。低估原因可能与活检钳取部位、组织量以及病理判断上的保守等相关。结论膀胱癌术前活检病理分级较术后低估比例达29．3%,在决定膀胱癌治疗方案时,应充分重视膀胱镜活检存在病理分级低估现象。
Objective To investigate the possible reasons for underestimation of pathological grading by preoperative cystoscopy in bladder cancer and to provide a more reliable basis for the selection of treatment options. Methods According to WHO / ISUP 1998 pathological grading criteria, 82 cases of bladder cancer were diagnosed as bladder cancer by biopsy before operation, and the grading of patients with complete histopathological examination was analyzed comparatively. Results The pathological grading of 82 preoperative biopsy specimens was G_1 35 cases, G_2 28 cases and G_3 19 cases. There were 22 cases of G_1, 32 cases of G_2 and 28 cases of G_3. There were 54 cases (65.8%) biopsy specimens and histopathological grading of the specimens, 24 cases (29.3%) were classified by biopsy, and 4 cases (4.9%) were classified by biopsy. The reasons for the underestimation may be related to the site of biopsy forceps, the amount of tissue, and the conservativeness in pathological judgment. Conclusion The preoperative biopsy of bladder cancer is less than the estimated value of postoperative biopsy grade 29.3%, in determining the treatment of bladder cancer, biopsy should pay due attention to the existence of undetectable pathological grading.