Surveillance and early diagnosis of hepatocellular carcinoma
Surveillance and early diagnosis of hepatocellular carcinoma
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DOI：
10.1016/s1590-8658(10)60509-9
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发表时间：
2010-07-01
影响因子：
4.5
通讯作者：
Lencioni, Riccardo
中科院分区：
文献类型：
--
作者：
Lencioni, Riccardo
发展为肝细胞癌（HCC）的高风险患者应参加基于超声（US）检查的监测计划，每6个月进行一次。在US监测期间发现的小于1 cm的结节应每隔3个月进行US随访。如果在US监测期间发现的结节大于1 cm，则应通过对比增强动态放射学研究（包括US、多探测器计算机断层扫描或磁共振成像）对其进行进一步研究。如果外观是典型的HCC（即，病变在动脉期显示血管过度形成，在门静脉或平衡期显示洗脱），活检被认为是不必要的，并且病变可以作为HCC治疗。对于1 - 2 cm之间的结节，目前建议此类非侵入性诊断基于来自至少两种动态成像技术的HCC典型巧合特征的证据。如果影像学上的血管轮廓不具有特征性，或者结节是在非炎性肝脏中检测到的，则应进行活检。如果活检结果为阴性，患者应每隔3个月进行一次影像学检查，直到结节消失、增大或显示出HCC的诊断特征。(C)2010年编辑意大利胃肠病学S.r.l.由爱思唯尔有限公司出版。保留所有权利。
Patients at high risk for developing hepatocellular carcinoma (HCC) should be enrolled in surveillance programs based on ultrasound (US) examinations performed at 6-month intervals. Nodules found during US surveillance that are smaller than 1 cm should be followed-up with US at 3-month intervals. If the nodule found during US surveillance is larger than 1 cm, it should be investigated further with contrast-enhanced dynamic radiological studies, including US, multidetector computed tomography, or magnetic resonance imaging. If the appearance is typical for HCC (i.e., the lesion shows hypervascularization in the arterial phase with washout in the portal venous or the equilibrium phase), biopsy is considered unnecessary and the lesion can be treated as HCC. For nodules between 1 and 2 cm, it is currently recommended that such non-invasive diagnosis be based on the evidence of coincidental features typical for HCC from at least two dynamic imaging techniques. If the vascular profile on imaging is not characteristic or the nodule is detected in a non-cirrhotic liver, biopsy should be performed. If the biopsy is negative for HCC, patients should be followed-up by imaging studies performed at 3-month intervals until the nodule either disappears, enlarges, or displays diagnostic characteristics of HCC. (C) 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.