术前肝活检在早期肝细胞癌的肝硬化患者中是一种安全且准确的肿瘤分级评估诊断工具。

Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumour grading assessment.

机构信息

Department of Clinical Medicine, University of Bologna, Italy.

出版信息

J Hepatol. 2011 Feb;54(2):300-5. doi: 10.1016/j.jhep.2010.06.037. Epub 2010 Sep 7.

DOI:10.1016/j.jhep.2010.06.037

Abstract

BACKGROUND & AIMS: Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma (HCC) because it can influence recurrence and survival after surgery. The accuracy of pre-operative needle core biopsy (NCB) in tumour grading has been assessed in only a few studies with conflicting results. Our aim was to determine the long-term safety and the overall accuracy of NCB in assessing tumour grading in subjects who had undergone liver resection for a single HCC.

METHODS

Eighty-one cirrhotic patients with HCC who had undergone NCB before liver resection were selected. Only patients with a single HCC and with at least a five-year-follow-up were included. Tumour grading was scored according to a modified Edmondson-Steiner classification: well/moderately (low grade) vs poorly-differentiated (high grade).

RESULTS

In the 81 patients with a solitary HCC (mean size 4.1 ± 2.3cm) tumour grade was correctly identified by NCB in 74 out of 81 (91.4%) HCCs. NCB overall sensitivity and specificity were 65% and 98.1%, respectively, with a PPV of 92% and an NPV of 91%. No major complications (in particular tumour seeding) were observed. The overall survival rates at 1, 3, and 5 years were 83%, 62%, and 44%, respectively; the recurrence rate after a 5-year-follow-up was 56.2% for low grade and 82.3% for high grade tumours (p<0.007).

CONCLUSIONS

Pre-operative NCB can be performed on early (<5 cm) HCC cirrhotic patients because it provides histologically useful information for HCC management with good accuracy and a low complication rate.

摘要

背景与目的

术前肿瘤分级知识对于肝细胞癌（HCC）的治疗至关重要，因为它会影响手术后的复发和生存。只有少数研究评估了术前针芯活检（NCB）在肿瘤分级中的准确性，且结果存在争议。我们的目的是确定 NCB 对单个 HCC 行肝切除患者肿瘤分级评估的长期安全性和总体准确性。

方法

选择 81 例因 HCC 行 NCB 后行肝切除术的肝硬化患者。仅纳入至少随访 5 年的单个 HCC 患者。肿瘤分级根据改良的 Edmondson-Steiner 分级系统进行评分：高分化（低级别）与中低分化（高级别）。

结果

在 81 例单发 HCC 患者（平均肿瘤直径 4.1±2.3cm）中，NCB 正确识别了 81 例中的 74 例（91.4%）肿瘤分级。NCB 的总敏感性和特异性分别为 65%和 98.1%，阳性预测值为 92%，阴性预测值为 91%。未观察到主要并发症（特别是肿瘤种植）。1、3、5 年总生存率分别为 83%、62%和 44%；5 年随访时低级别和高级别肿瘤的复发率分别为 56.2%和 82.3%（p<0.007）。