,et al. EAU guidelines on the diagnosis and treatment of urothelial carcinoma in situ. European Urology, 2005, 48: 363-371. 9原位癌的诊断-膀胱镜?膀胱镜下呈现红色多灶天鹅绒样典型病变。?与炎症不易区分,有时不可见? 30% of specimens with grade 2 dysplasia and 53% of specimens with CIS were missed under white light endoscopy - Zaak D, et al: Role of aminolevulinic acid in the detection of urothelial premaligant lesions. Cancer 95: 1234 – 1238, 2002 ?对于异常尿路上皮,需行常规活检或电切活检。?尿脱落细胞学阳性时,但膀胱外观正常时需随机活检。? TaT1 期肿瘤,不推荐常规行随机活检?但 TaT1 期肿瘤,尿脱落细胞学阳性时或者外向生长的肿瘤呈现非乳头状样外观时需随机活检。 10 原位癌的诊断-光动力学诊断? Photodynamic Diagnosis PDD ,用光敏剂(如 hexylaminolaevulinate , HAL )膀胱灌注,感光性的物质在快速生长的细胞(如肿瘤细胞)中选择性积聚,再应用特定(荧光)膀胱镜在特定光背景下检查?所有肿瘤来说,检出率提高 20% ; CIS 提高 23% Kausch I, et al. Eur Urol 2010;57:595 – 60 ?但炎症,最近的电切及前三个月的 BCG 灌注均能诱导产生假阳性。?.
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