Livraghi T, Sangalli G, Giordano F, Ravetto C, Solbiati L, Fornari F, Cavanna L, Matricardi L, Gagliano E
Servizio di Radiologia, Ospedale Civile, Vimercate, Italia.
Tumori. 1987 Oct 31;73(5):507-12. doi: 10.1177/030089168707300514.
Two hundred and forty cases of hepatocellular carcinomas (HCC), diagnosed by ultrasonography and fine needle biopsy, were studied. The following parameters were investigated: 1. echo features (240 cases) - hypoechoic, 54; hyperechoic, 56; complex, 112; isoechoic with halo, 18; 2. tumor size (240 cases) - single tumor under 4.5 cm, 30; single tumor over 4.5 cm, 74; multiple masses or diffuse, 136; 3. cytologic pattern (240 cases) - well and medium differentiated, 144; pleomorphic, 43; poorly differentiated, 28; unclassified, 25; 4. histologic pattern (157 cases) - trabecular, 74; solid, 42; acinar, 1; mixed, 2; unclassified, 38; 5. alpha-fetoprotein (AFP) level (185 cases) - under 20 ng/ml, 79; between 20 and 320 ng/ml, 40; over 320 ng/ml, 66; 6. HBs Ag (208 cases) - present in 56 cases; 7. cirrhosis (102 cases) - present in 79 cases. Some of the above parameters were correlated with one another. There was: 1. a highly significant frequency of the hypoechoic feature among small HCC; 2. a percentage of AFP-producing tumors increasing with tumor size; 3. no relationship between AFP production and cytologic or histologic pattern; 4. no relationship between tumor size and cytologic or histologic pattern. However, among the small HCC, all the 9 HCC with a diameter of less than 3 cm showed a trabecular pattern and well-differentiated cells. Cirrhosis was present in every patient with a small HCC. Since the discovery of a small HCC is an incidental ultrasonographic finding in the context of severe liver disease, ultrasonographic monitoring of cirrhotic patients is the best available strategy to screen for small HCC.
对240例经超声检查和细针穿刺活检确诊的肝细胞癌（HCC）患者进行了研究。研究了以下参数：1. 回声特征（240例）——低回声，54例；高回声，56例；混合回声，112例；有晕环的等回声，18例；2. 肿瘤大小（240例）——单个肿瘤直径小于4.5 cm，30例；单个肿瘤直径大于4.5 cm，74例；多个肿块或弥漫性病变，136例；3. 细胞学类型（240例）——高分化和中分化，144例；多形性，43例；低分化，28例；未分类，25例；4. 组织学类型（157例）——小梁状，74例；实性，42例；腺泡状，1例；混合性，2例；未分类，38例；5. 甲胎蛋白（AFP）水平（185例）——低于20 ng/ml，79例；20至320 ng/ml之间，40例；高于320 ng/ml，66例；6. HBs Ag（208例）——56例呈阳性；7. 肝硬化（102例）——79例存在肝硬化。上述一些参数之间存在相关性。具体如下：1. 小肝癌中低回声特征出现的频率非常高；2. 产生AFP的肿瘤百分比随肿瘤大小增加；3. AFP产生与细胞学或组织学类型之间无相关性；4. 肿瘤大小与细胞学或组织学类型之间无相关性。然而，在小肝癌中，所有9例直径小于3 cm的肝癌均表现为小梁状结构和高分化细胞。每例小肝癌患者均存在肝硬化。由于小肝癌是在严重肝病背景下偶然通过超声检查发现的，因此对肝硬化患者进行超声监测是筛查小肝癌的最佳可用策略。
