Gambarin-Gelwan M, Wolf D C, Shapiro R, Schwartz M E, Min A D
Department of Medicine, Mount Sinai Medical Center, New York, New York, USA.
Am J Gastroenterol. 2000 Jun;95(6):1535-8. doi: 10.1111/j.1572-0241.2000.02091.x.
Recognition of hepatocellular carcinoma (HCC) is important in the management of patients awaiting liver transplantation. HCCs >5 cm in diameter are at high risk to recur after transplant. The goal of this study was to assess the sensitivity of the diagnostic tests employed in a pretransplant screening program.
The study is a retrospective analysis of charts of 106 consecutive adults transplanted over a 1-yr period. All patients had ultrasonography (US), computerized tomography (CT), and serum alpha fetoprotein (AFP) testing within 6 months of transplantation. Radiographic reports were subdivided into low-risk and high-risk groups, based upon level of suspicion for HCC. The results were compared to explant pathology.
Pathological analysis of 106 explants revealed HCC in 19 patients. High-risk US exams had a positive predictive value (PPV) of 0.69 and a negative predictive value (NPV) of 0.91 in the diagnosis of HCC. High-risk CT exams had a PPV of 0.67 and an NPV of 0.90. When patients had either a high-risk US or a high-risk CT, there was a PPV of 0.59 and an NPV of 0.83. Of the 19 patients with HCC, three had high-risk US and low-risk CT; two had high-risk CT and low-risk US. Four patients, all with HCC <4 cm, had low-risk US, CT, and serum AFP.
US, CT, and serum AFP, as single tests, are insensitive for detection of HCC in the cirrhotic liver. However, they are highly specific. Sensitivity and specificity for US are comparable to those for CT. Given its lower cost, US is preferable to CT for routine screening of HCC in patients with end-stage liver disease undergoing liver transplantation.
在等待肝移植患者的管理中，识别肝细胞癌（HCC）很重要。直径>5 cm的HCC移植后复发风险高。本研究的目的是评估移植前筛查项目中所采用诊断测试的敏感性。
本研究是对106例在1年期间连续接受移植的成年患者病历进行的回顾性分析。所有患者在移植前6个月内均接受了超声检查（US）、计算机断层扫描（CT）和血清甲胎蛋白（AFP）检测。根据对HCC的怀疑程度，将影像学报告分为低风险和高风险组。将结果与移植肝病理结果进行比较。
对106例移植肝的病理分析显示19例患者患有HCC。在HCC诊断中，高风险US检查的阳性预测值（PPV）为0.69，阴性预测值（NPV）为0.91。高风险CT检查的PPV为0.67，NPV为0.90。当患者有高风险US或高风险CT时，PPV为0.59，NPV为0.83。在19例HCC患者中，3例有高风险US和低风险CT；2例有高风险CT和低风险US。4例患者的HCC均<4 cm，其US、CT和血清AFP均为低风险。
单独使用US、CT和血清AFP检测肝硬化肝脏中的HCC不敏感。然而，它们具有高度特异性。US的敏感性和特异性与CT相当。鉴于其成本较低，如果对接受肝移植的终末期肝病患者进行HCC常规筛查，US比CT更可取。
