Caturelli Eugenio, Ghittoni Giorgia, Roselli Paola, De Palo Mariagrazia, Anti Marcello
Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
Liver Transpl. 2004 Feb;10(2 Suppl 1):S26-9. doi: 10.1002/lt.20037.
Guided biopsy of hepatocellular carcinoma has been recently discussed again due to the progress of imaging techniques and the risk of malignant seeding after the procedure. Ultrasound is probably still the most accurate imaging modality for early detection of nodules arising on cirrhosis, even when compared with more advanced imaging techniques. It can be easily employed in the surveillance of high-risk cirrhotic patients. Ultrasound-guided biopsy has very high sensitivity and almost absolute specificity, which allows the appropriate treatment to start after a positive diagnosis. It also allows correct diagnosis of lymphomatous nodules, the incidence of which is increased in hepatitis C virus-related cirrhosis. The risk of seeding appears limited according to the currently available epidemiological data; this should be considered against the risk of false-positive diagnosis of malignancy based on imaging studies alone. Ultrasound-guided biopsy is a valuable tool also for the diagnosis of small nodules (less than 10 mm in diameter). The best accuracy in the sampling of hepatocellular carcinoma nodules is obtained by combining smear cytology and microhistology. This can be achieved by a single biopsy with a fine cutting needle that furnishes pathologic material suitable for both examinations, reducing risks and costs.
由于成像技术的进步以及活检术后恶性肿瘤种植的风险，肝细胞癌的引导活检最近再次受到讨论。超声可能仍然是早期发现肝硬化结节最准确的成像方式，即使与更先进的成像技术相比也是如此。它可以很容易地用于高危肝硬化患者的监测。超声引导活检具有非常高的敏感性和几乎绝对的特异性，这使得在阳性诊断后能够开始适当的治疗。它还能正确诊断淋巴瘤结节，在丙型肝炎病毒相关肝硬化中其发生率会增加。根据目前可得的流行病学数据，种植风险似乎有限；这应该与仅基于影像学研究的恶性肿瘤假阳性诊断风险相权衡。超声引导活检对于诊断小结节（直径小于10毫米）也是一种有价值的工具。通过将涂片细胞学和显微组织学相结合，在肝细胞癌结节采样中可获得最佳准确性。这可以通过使用细切割针进行单次活检来实现，该活检提供适合两种检查的病理材料，降低风险和成本。
