Caselitz M, Masche N, Bleck J S, Gebel M, Atay Z, Stern C, Manns M P, Kubicka S
Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover.
Z Gastroenterol. 2003 Jun;41(6):559-64. doi: 10.1055/s-2003-39637.
Increasing sensitivity of morphological diagnosis by combination of cytological and fine-needle histological examination after ultrasound guided fine needle biopsy in hepatocellular carcinoma (HCC).
We investigated the factors which may affect the sensitivity of morphological diagnostics (cytology and fine-needle histology) in HCC after ultrasound guided biopsy.
In 62 patients, an ultrasound guided cytological (n = 62) and fine-needle histological (n = 45) biopsy was performed. In addition, the smears were investigated by cytophotometry (n = 62).
Considering each method separately, the sensitivity of both cytological and histological diagnostics was about 80%. The sensitivity could be raised to 89% by combining the two methods. In seven patients, the HCC could not be primarily confirmed morphologically. In nine patients, the result of histological and cytological investigation was not congruent. With regard to the size of the biopsied lesion, tumor stage, cytophotometric finding and survival these 16 patients (group A) were compared with the 46 patients in whom the HCC could be primarily confirmed morphologically (group B). The statistical analysis did reveal a significantly lower percentage of tumors with diploid or tetraploid (euploid) cells in group B. Euploid tumors were significantly more highly differentiated. In patients with euploid tumors, the sensitivity of the cytological investigation was 67% and respectively 75% of the histological investigation. The sensitivity could be raised to 82% in this population by combining the two investigations. On the other hand in aneuploid tumors, the sensitivity could only be increased from 93% and 88% respectively to 97% by combining cytology and fine-needle histology.
Our investigations show that the sensitivity of morphological diagnostics can be raised especially in the highly differentiated HCC with a physiological DNA content by combination of cytological and fine-needle histological investigations.
在肝细胞癌（HCC）中，超声引导下细针穿刺活检后，通过细胞学和细针组织学检查相结合提高形态学诊断的敏感性。
我们研究了超声引导活检后可能影响HCC形态学诊断（细胞学和细针组织学）敏感性的因素。
对62例患者进行了超声引导下的细胞学（n = 62）和细针组织学（n = 45）活检。此外，对涂片进行了细胞光度测定（n = 62）。
分别考虑每种方法时，细胞学和组织学诊断的敏感性均约为80%。将两种方法结合可将敏感性提高到89%。7例患者的HCC最初无法通过形态学确诊。9例患者的组织学和细胞学检查结果不一致。就活检病变的大小、肿瘤分期、细胞光度测定结果和生存率而言，将这16例患者（A组）与46例最初可通过形态学确诊HCC的患者（B组）进行了比较。统计分析确实显示，B组中具有二倍体或四倍体（整倍体）细胞的肿瘤百分比显著较低。整倍体肿瘤的分化程度明显更高。在整倍体肿瘤患者中，细胞学检查的敏感性为67%，组织学检查的敏感性分别为75%。通过将两种检查相结合，该人群的敏感性可提高到82%。另一方面，在非整倍体肿瘤中，通过将细胞学和细针组织学相结合，敏感性仅分别从93%和88%提高到97%。
我们的研究表明，通过细胞学和细针组织学检查相结合，形态学诊断的敏感性可以提高，尤其是在具有生理性DNA含量的高分化HCC中。
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