Buscarini L, Sbolli G, Cavanna L, Civardi G, Di Stasi M, Buscarini E, Fornari F
Oncology. 1987;44(2):93-7. doi: 10.1159/000226453.
We analyzed the clinical-diagnostic features of 67 cases of hepatocellular carcinoma (HCC) collected from June 1981 to December 1985. The male-to-female ratio was 3.4:1, the average age was 66.7 years; alcohol abuse was present in 38 cases (56.7%); HbsAg positivity was present in 10 of 62 patients (16.1%); the alpha-fetoprotein (AFP) level was greater than 500 ng in 17 of 61 patients (28%) and normal in 24 of 61 (39.3%). Concomitant cirrhosis was found in 51 patients (76.1%). The median survival of the whole group was of 10 weeks from diagnosis. The clinical suspicion of HCC was arisen by ultrasound (US) and the diagnostic was confirmed cytologically in 57 patients out of 60 who underwent ultrasonically guided fine-needle biopsy (UG-FNB), with a sensitivity of 95% and specificity of 100%. In 7 cases (including the 3 false-negative FNB), the diagnosis was made by laparoscopic biopsy and, in 3 cases, on autopsy. US identified a single tumor in 27 cases (40.3%); 7 were smaller than 5 cm. Only 4 patients (5.9%) were considered for surgery. We conclude that the cirrhotic patients (above all those HbsAg positive) constitute a high-risk group requiring periodic (every 3 months) US examination. To confirm the HCC, we believe in the high diagnostic accuracy of UG-FNB, whereas laparoscopy should be confirmed to the cases where FNB gives a doubtful false-negative result or to complete the presurgical staging.
我们分析了1981年6月至1985年12月收集的67例肝细胞癌（HCC）的临床诊断特征。男女比例为3.4:1，平均年龄为66.7岁；38例（56.7%）存在酗酒情况；62例患者中有10例（16.1%）乙肝表面抗原（HbsAg）呈阳性；61例患者中有17例（28%）甲胎蛋白（AFP）水平大于500 ng，61例中有24例（39.3%）正常。51例（76.1%）伴有肝硬化。全组从诊断起的中位生存期为10周。临床对HCC的怀疑通过超声（US）产生，60例接受超声引导下细针穿刺活检（UG-FNB）的患者中有57例通过细胞学确诊，敏感性为95%，特异性为100%。7例（包括3例假阴性FNB）通过腹腔镜活检确诊，3例通过尸检确诊。US在27例（40.3%）中发现单个肿瘤；7个肿瘤小于5 cm。仅4例患者（5.9%）考虑手术。我们得出结论，肝硬化患者（尤其是那些HbsAg阳性者）构成一个高危组，需要定期（每3个月）进行US检查。为确诊HCC，我们相信UG-FNB具有很高的诊断准确性，而腹腔镜检查应适用于FNB给出可疑假阴性结果的病例或用于完善术前分期。
