PERCUTANEOUS BIOPSY OF PORTAL-VEIN THROMBUS - A NEW STAGING TECHNIQUE FOR HEPATOCELLULAR-CARCINOMA
PERCUTANEOUS BIOPSY OF PORTAL-VEIN THROMBUS - A NEW STAGING TECHNIQUE FOR HEPATOCELLULAR-CARCINOMA
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DOI：
10.2214/ajr.161.2.8392785
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发表时间：
1993-08-01
影响因子：
5
通讯作者：
CARR, BI
中科院分区：
文献类型：
--
作者：
DODD, GD;CARR, BI
OBJECTIVE.肝细胞癌的准确分期对确定适当的治疗是必要的。尤其是门静脉的肿瘤侵犯是肝切除或肝移植的禁忌症。不幸的是，影像学检查并不能总是区分良性和恶性门静脉血栓。因此，我们进行了一项研究，以确定超声引导下经皮穿刺门静脉血栓活检作为肝细胞癌患者分期技术的有效性和安全性。我们对12名男性和2名女性（43-76岁）正在考虑进行肝切除或肝移植的门静脉血栓进行了经皮活检。所有患者均为肝硬化，13例经组织学证实为肝内肝癌。在连续彩色多普勒超声引导下，使用20号抽吸针和闭塞探针进行活检。在取出探针之前，将每根针的头端嵌入血栓中。在抽吸过程中，小心控制针头，使其尖端保持在门静脉腔内。为了评估可能的假阳性结果，在5名患者中，仅在肝实质中插入和取出一根额外的相同针。在所有14例患者中获得了足够的标本。12份标本含有恶性肝细胞，2份含有良性血栓。其中一个良性血栓的病人谁有一个3厘米的肝细胞癌的实质被证实，检查切除的肝脏移植后。另一例良性血栓患者没有肝细胞癌的临床或影像学证据。未发生与活检相关的并发症。对照针头均不含肝细胞。患者在活检期间的不适与之前肝活检期间经历的不适大致相同。平均手术时间为20 min。超声引导下经皮穿刺门静脉血栓活检是一种安全、准确、有用和耐受性良好的肝细胞癌分期诊断方法。
OBJECTIVE. Accurate staging of hepatocellular carcinoma is necessary to determine appropriate treatment. In particular, neoplastic invasion of the portal vein is a contraindication for hepatic resection or transplantation. Unfortunately, imaging cannot always differentiate benign from malignant portal vein thrombi. We therefore undertook a study to determine the efficacy and safety of sonographically guided percutaneous biopsy of portal vein thrombi as a staging technique for patients with hepatocellular carcinoma.SUBJECTS AND METHODS. We performed percutaneous biopsy of portal vein thrombi in 12 men and two women (43-76 years old) who were being considered for hepatic resection or transplantation. All of the patients had hepatic cirrhosis and 13 had histologically proved intrahepatic hepatocellular carcinoma. Biopsies were performed under continuous color Doppler sonographic guidance by using 20-gauge aspiration needles with occlusive stylets. Each needle was positioned with its tip embedded in the thrombus before the stylet was removed. During aspiration, the needle was carefully controlled to keep its tip within the lumen of the portal vein. To evaluate for possible false-positive results, an additional identical needle was passed in and out of only the hepatic parenchyma in five patients.RESULTS. Adequate specimens were obtained in all 14 patients. Twelve specimens contained malignant hepatocytes, and two contained benign thrombi. One of the benign thrombi in a patient who had a 3-cm hepatocellular carcinoma of the parenchyma was confirmed by examining the resected liver after transplantation. The other patient who had a benign thrombus had no clinical or imaging evidence of hepatocellular carcinoma. No complications associated with biopsy occurred. None of the control needles contained hepatocytes. The patients' discomfort during biopsy was approximately the same as the discomfort experienced during previous liver biopsies. The average length of the procedure was 20 min.CONCLUSION. Sonographically guided percutaneous biopsy of portal vein thrombi is a safe, accurate, useful, and well-tolerated diagnostic procedure for the staging of hepatocellular carcinoma.