Yang Long, Lin Li-Wu, Lin Xue-Ying, Gao Shang-Da, He Yi-Mi, Yang Fa-Duan, Xue En-Sheng, Lin Xiao-Dong
Department of Ultrasound, Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Hepatobiliary Pancreat Dis Int. 2005 May;4(2):234-8.
Portal vein tumor thrombosis (PVTT) is a serious complication and a major metastatic way of hepatocellular carcinoma(HCC). But portal vein benign thrombosis(PVBT) always appears in patients with hepatocirrhosis, and PVTT should be differentiated from PVBT. The aim of this study was to probe the value of ultrasound-guided fine needle aspiration biopsy in differential diagnosis of PVTT.
Twenty-two HCC patients with portal vein thrombosis and 8 hepatocirrhosis patients with portal vein thrombosis were studied by ultrasound-guided fine needle aspiration biopsy. Twelve portal vein thrombosis filling portal vein embranchment of the 30 portal vein thrombosis patients were examined by 18G automatic biopsy. The positive rates of aspiration biopsy cytology and histology were calculated and compared with those of automatic biopsy.
The positive rates of fine needle aspiration biopsy cytology and histology were 93.3% (28/30) and 90.0% (27/30), respectively. They were not different markedly from that of automatic biopsy 91.7% (11/12). In aspiration biopsy of 22 HCC patients with PVTT, HCC cellular was found in 19 portal vein thrombosis patients (86.4%) by cytology examination and in 18 portal vein thrombosis patients (81.8%) by histology examination. In total, 20 tumor thrombi were detected. The other two were diagnosed as benign thrombosis. No HCC cell and/or tissue was observed in 8 patients with hepatocirrhosis associated with portal vein thrombosis.
Ultrasound-guided fine needle biopsy in detecting PVTT shows a high positive rate and is of diagnostic value. The positive rate is not apparently different from that of automatic biopsy. Hence the case that fails to be diagnosed by color Doppler flow imaging(CDFI) and pulsed Doppler can be detected early by ultrasound-guided fine needle aspiration biopsy.
门静脉肿瘤血栓形成（PVTT）是肝细胞癌（HCC）的一种严重并发症及主要转移途径。但门静脉良性血栓形成（PVBT）常见于肝硬化患者，PVTT需与PVBT相鉴别。本研究旨在探讨超声引导下细针穿刺活检在PVTT鉴别诊断中的价值。
对22例伴有门静脉血栓形成的HCC患者及8例伴有门静脉血栓形成的肝硬化患者进行超声引导下细针穿刺活检。对30例门静脉血栓形成患者中12例门静脉分支被血栓充填的患者采用18G自动活检针进行取材。计算穿刺活检细胞学及组织学的阳性率，并与自动活检的阳性率进行比较。
细针穿刺活检细胞学及组织学阳性率分别为93.3%（28/30）和90.0%（27/30）。与自动活检的阳性率91.7%（11/12）相比，差异无统计学意义。在22例PVTT的HCC患者穿刺活检中，细胞学检查发现19例门静脉血栓形成患者（86.4%）存在HCC细胞，组织学检查发现18例门静脉血栓形成患者（81.8%）存在HCC细胞。共检出20个肿瘤血栓，另外2个被诊断为良性血栓。8例伴有门静脉血栓形成的肝硬化患者未观察到HCC细胞和/或组织。
超声引导下细针穿刺活检诊断PVTT阳性率高，具有诊断价值，阳性率与自动活检差异不明显。因此，彩色多普勒血流成像（CDFI）及脉冲多普勒未能诊断的病例，可通过超声引导下细针穿刺活检早期发现。
