Department of Radiology, Division of Abdominal Imaging, Washington University School of Medicine in St. Louis, Mail Stop 8131, 510 S. Kingshighway Blvd, St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 2013 Aug;201(2):332-9. doi: 10.2214/AJR.12.9488.
The purpose of this study was to evaluate the diagnostic accuracy of preoperative imaging for diagnosis of combined hepatocellular cholangiocarcinoma tumors and to evaluate the clinical and imaging features and demographics of patients presenting to our institution with such tumors.
From January 2001 to January 2011, 29 patients presented with pathologically proven combined hepatocellular cholangiocarcinoma tumors to our institution. A retrospective review of the imaging studies, clinical data, and demographic information in these patients was conducted. Two radiologists with 6 and 18 years of experience reviewed the imaging studies of patients with combined hepatocellular cholangiocarcinoma tumors and matched control cases of hepatocellular carcinoma (HCC) (n = 15) and cholangiocarcinoma (n = 18). The reviewers were blinded to the pathologic diagnosis. Imaging features on contrast-enhanced MRI and CT with the suggested final diagnosis were recorded.
The demographics of our patient population were similar to other reported U.S. populations, with cirrhosis and hepatitis present in a minority of patients. The imaging features of combined hepatocellular cholangiocarcinoma tumors overlapped with those of HCC and cholangiocarcinoma. The correct diagnosis of combined hepatocellular cholangiocarcinoma tumors was made in a minority of cases by either radiologist, with misdiagnosis more often leading to suggestion of cholangiocarcinoma than HCC. Sensitivities and specificities for diagnosis of combined hepatocellular cholangiocarcinoma tumors ranged from 33% to 34% and 81% to 100%, respectively.
Preoperative diagnosis of combined hepatocellular cholangiocarcinoma tumors on the basis of imaging features is accurate in the minority of cases. Tumor markers and risk factors may help improve accuracy; however, in the absence of classic imaging features and supportive information for HCC or cholangiocarcinoma, biopsy should be considered for confirmation of diagnosis.
本研究旨在评估术前影像学诊断混合细胞型肝癌的准确性，并评估我院此类肿瘤患者的临床、影像学特征和人口统计学特征。
2001 年 1 月至 2011 年 1 月，29 例经病理证实为混合细胞型肝癌的患者在我院就诊。对这些患者的影像学研究、临床数据和人口统计学信息进行回顾性分析。两名具有 6 年和 18 年经验的放射科医生回顾了混合细胞型肝癌患者和匹配的肝细胞癌（HCC）（n=15）和胆管癌（n=18）的影像学资料。两位阅片医生对患者的病理诊断并不知情。记录了增强 MRI 和 CT 的影像学特征，并给出了最终的诊断建议。
我们的患者人群的人口统计学特征与其他报道的美国人群相似，少数患者存在肝硬化和肝炎。混合细胞型肝癌的影像学特征与 HCC 和胆管癌重叠。两位放射科医生均未能准确诊断混合细胞型肝癌，误诊更常导致胆管癌的诊断，而不是 HCC。对混合细胞型肝癌的诊断的敏感性和特异性分别为 33%至 34%和 81%至 100%。
基于影像学特征对混合细胞型肝癌的术前诊断准确率较低。肿瘤标志物和危险因素可能有助于提高准确性；但是，如果没有 HCC 或胆管癌的典型影像学特征和支持性信息，则应考虑活检以确认诊断。
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