Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades
Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades
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DOI：
10.1111/j.1440-1746.2007.04924.x
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发表时间：
2008-07-01
影响因子：
4.1
通讯作者：
Lin, Shi-Ming
中科院分区：
文献类型：
--
作者：
Lin, Chen-Chun;Lin, Chun-Jung;Lin, Shi-Ming
背景：通过细针穿刺（FNA）细胞学鉴别异型增生和肝细胞癌（HCC）是困难的。本研究的目的是诊断肝细胞癌和肝细胞异型增生的区别，从肝细胞癌与不同级别的解释和评分的细胞形态学features.Methods：83例肝癌患者进行了超声引导下FNA和随后的针吸活检的肿瘤。术后随访2年以上，经病理证实68例为肝癌，15例为肝硬化伴异型增生。结果：2例高分化肝癌患者术前诊断为HCC阴性，术后随访3 ~ 12个月，均未发现HCC。FNA细胞学诊断HCC的敏感性、特异性、假阳性、假阴性和准确性分别为97%、100%、0%、3%和97.6%。异型增生评分为20.8 +/- 1.3（平均值+/- SD），Edmondson I级HCC的异型增生评分低于26.2 +/- 3.4（P < 0.01），II级HCC为28.9 +/- 2.9（P < 0.01），III/IV级HCC为34.9 +/- 4.3（P < 0.01）。II级HCC的FNA评分明显低于III/IV级HCC（P < 0.01）。结论：FNA对不同分级HCC与异型增生的鉴别诊断具有较高的准确性。肝细胞异型增生的细胞形态学评分与不同分级的HCC有较好的相关性。异型增生显示最低评分，从异型增生到III/IV级HCC评分依次增加。
Background: Distinguishing dysplasia from hepatocellular carcinoma (HCC) by fine-needle aspiration (FNA) cytology is difficult. The aim of this study was to diagnose HCC and the distinction of liver cell dysplasia from HCC with different grades by interpreting and scoring the cyto-morphological features.Methods: Eighty-three cirrhotic patients undertook a sonography-guided FNA and subsequent needle biopsy for the tumor. HCC was confirmed in 68 cases and cirrhosis with dysplasia in 15 cases by pathology and follow-up for longer than 2 years. Eighteen cytological features were scored as degree of one, two or three according to their presence or prominence.Results: Two cases of well-differentiated HCC were diagnosed as negative for HCC initially. The sensitivity, specificity, false positive, false negative and accuracy were 97%, 100%, 0%, 3% and 97.6% for FNA cytology in the diagnosis of HCC, respectively. The score of dysplasia was 20.8 +/- 1.3 (mean +/- SD) and lower than 26.2 +/- 3.4 in Edmondson's grade I HCC (P < 0.01), 28.9 +/- 2.9 in grade II HCC (P < 0.01), and 34.9 +/- 4.3 in grade III/IV HCC (P < 0.01). The score was also significantly lower in grade II HCC than in grade III/IV HCC (P < 0.01).Conclusions: FNA yielded a high accuracy in the distinction of dysplasia from HCC with different grades. There is a good correlation in cyto-morphological scores of liver cell dysplasia and HCC with different grades. Dysplasia displayed the lowest score and the score increased in order from dysplasia to grade III/IV HCC.