Herman P, Pugliese V, Machado M A, Montagnini A L, Salem M Z, Bacchella T, D'Albuquerque L A, Saad W A, Machado M C, Pinotti H W
Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, R. Eneas de Carvalho Aguiar, 255, São Paulo, CEP 05403-900, Brazil.
World J Surg. 2000 Mar;24(3):372-6. doi: 10.1007/s002689910059.
The diagnosis of benign hepatic tumors as hepatic adenoma (HA) and focal nodular hyperplasia (FNH) remains a challenge for clinicians and surgeons. The importance of differentiating between these lesions is based on the fact that HA must be surgically resected and FNH can be only observed. A series of 23 female patients with benign liver tumors (13 FNH, 10 HA) were evaluated, and a radiologic diagnostic algorithm was employed with the aim of establishing preoperative criteria for the differential diagnosis. All patients were submitted to surgical biopsy or hepatic resection to confirm the diagnosis. Based only on clinical and laboratory data, distinction was not possible. According to the investigative algorithm, the diagnosis was correct in 82.6% of the cases; but even with the development of imaging methods, which were used in combination, the differentiation was not possible in four patients. For FNH cases scintigraphy presented a sensitivity of 38.4% and specificity of 100%, whereas for HA the sensitivity reached 60% and specificity 85.7%. Magnetic resonance imaging, employed when scintigraphic findings were not typical, presented sensitivities of 71.4% and 80% and specificities of 100% and 100% for FNH and HA, respectively. Preoperative diagnosis of FNH was possible in 10 of 13 (76.9%) patients and was confirmed by histology in all of them. In one case, FNH was misdiagnosed as HA. The diagnosis of HA was possible in 9 of 10 (90%) adenoma cases. Surgical biopsy remains the best method for the differential diagnosis between HA and FNH and must be performed in all doubtful cases. Surgical resection is the treatment of choice for all patients with adenoma and can be performed safely. With the evolution of imaging methods it seems that the preoperative diagnosis of FNH may be considered reliable, thereby avoiding unnecessary surgical resection.
将良性肝肿瘤诊断为肝腺瘤（HA）和局灶性结节性增生（FNH）对临床医生和外科医生来说仍然是一项挑战。区分这些病变的重要性在于，HA必须进行手术切除，而FNH只需观察。我们评估了23例患有良性肝肿瘤的女性患者（13例FNH，10例HA），并采用了一种放射学诊断算法，旨在建立术前鉴别诊断标准。所有患者均接受手术活检或肝切除以确诊。仅根据临床和实验室数据，无法进行区分。根据该研究算法，82.6%的病例诊断正确；但即使联合使用了成像方法，仍有4例患者无法进行区分。对于FNH病例，闪烁扫描的敏感性为38.4%，特异性为100%，而对于HA，敏感性达到60%，特异性为85.7%。当闪烁扫描结果不典型时使用的磁共振成像，对FNH和HA的敏感性分别为71.4%和80%，特异性分别为100%和100%。13例患者中有10例（76.9%）术前诊断为FNH，所有病例均经组织学证实。有1例FNH被误诊为HA。10例腺瘤病例中有9例（90%）可诊断为HA。手术活检仍然是HA和FNH鉴别诊断的最佳方法，所有可疑病例均必须进行。手术切除是所有腺瘤患者的首选治疗方法，且可以安全进行。随着成像方法的发展，似乎FNH的术前诊断可以被认为是可靠的，从而避免不必要的手术切除。
