Frider B, Rebora N, Bistoletti R, Ocampo C, Sookoian S, Oría A
Unidad A Clínica Médica-Hepatología, Hospital General de Agudos C. Argerich, Asociado a la Universidad de Buenos Aires, Argentina.
G E N. 1992 Jul-Sep;46(3):218-22.
The aim of this work was to evaluate the diagnostic reliability of fine needle cytology guided by ultrasonography in hepatic masses. One hundred and fifty nine patients underwent this procedure. The final diagnosis was confirmed by histology obtained by percutaneous biopsy, surgery, laparoscopy and necropsy or adequate clinical follow-up in 139 cases. Twenty cases were excluded since no final diagnosis was available. In 102 cases the method was applied on an outpatient basis, while the remainder were hospitalized. There were 9 (6.4%) false negatives, whose final diagnosis were hepatocarcinoma in 4, adenocarcinoma in 3, cholangiocarcinoma in 1 and in a non Hodgkin lymphoma. The global sensitivity of the method was 93.5%, the specificity 100% and the efficiency 93.5%. In hepatocarcinomas the sensitivity was 73.3%, the specificity 100% and the efficiency 73.3%. In metastatic adenocarcinomas the sensitivity was 96.2%, the specificity 100% and the efficiency 73.3%. Except for a single hepatocarcinoma patient who developed hemoperitoneum and 2 patients who required parenteral analgesics, complications were entirely lacking. Fine needle cytology guided by ultrasonography in hepatic masses is a highly efficient method to confirm, rule out and stage liver malignancy and benign lesions in a fast low-cost fashion. The low sensitivity in hepatocarcinomas is attributable to tumor size and histological differentiation.
本研究旨在评估超声引导下肝肿块细针穿刺细胞学检查的诊断可靠性。159例患者接受了该检查。139例患者通过经皮活检、手术、腹腔镜检查、尸检或充分的临床随访获得组织学检查结果，从而确诊。20例因未获得最终诊断结果而被排除。102例患者在门诊接受了该检查，其余患者住院检查。有9例（6.4%）假阴性，其中最终诊断为肝癌4例、腺癌3例、胆管癌1例和非霍奇金淋巴瘤1例。该方法的总体敏感性为93.5%，特异性为100%，效率为93.5%。在肝癌中，敏感性为73.3%，特异性为100%，效率为73.3%。在转移性腺癌中，敏感性为96.2%，特异性为100%，效率为73.3%。除1例肝癌患者发生腹腔积血和2例患者需要注射镇痛剂外，未出现其他并发症。超声引导下肝肿块细针穿刺细胞学检查是一种高效的方法，能够以快速、低成本的方式确诊、排除肝恶性肿瘤及良性病变并进行分期。肝癌中低敏感性归因于肿瘤大小和组织学分化。
