Szpakowski Jean-Luc, Drasin Todd E, Lyon Liisa L
Gastroenterology Department Kaiser Permanente Fremont CA.
Radiology Department Kaiser Permanente Walnut Creek CA.
Hepatol Commun. 2017 Sep 29;1(9):841-851. doi: 10.1002/hep4.1089. eCollection 2017 Nov.
Biopsies of liver masses that prove to be hepatocellular carcinomas (HCCs) are associated with a risk of seeding the abdominal or chest wall with tumor cells. The reported frequency of seeding varies greatly in the literature. We performed a retrospective cohort study in a large integrated health care system to examine rates of seeding in patients with HCC who had targeted liver biopsies, ablations, or both performed by community radiologists. We reviewed pathology and radiology records to determine the occurrence of wall seeding, defined as a chest or abdominal wall lesion along a definite or probable needle tract. A total of 1,015 patients had targeted liver biopsies (795), ablations (72), or both (148). Multiple procedures were done in 284 patients (28%). Six cases of seeding were identified. The rate of wall seeding was 2/795 patients (0.13%; 95% confidence interval [CI], 0.00%-0.60%) if only biopsies were done versus 4/220 (1.82%; 95% CI, 0.05%-3.58%) if ablations were performed (= 0.01). The rate was 0/72 (0.00%; 95% CI, 0.00%-0.04%) with ablations alone and 4/148 (2.70%; 95% CI, 0.74%-6.78%) if both procedures were done ( = 0.31). Of those with 1 year follow-up (n = 441), the rate of seeding was 2/269 (0.74%; 95% CI, 0.00%-1.77%) if biopsies alone were done and 4/172 (2.33%; 95% CI, 0.07%-4.58%) if ablations were done. In none of the cases was the seeding a proximate cause of death. : Biopsies of liver masses are associated with a low rate of wall seeding when performed in a community setting and when they are the sole procedures. Ablations may have a higher rate of seeding, particularly if done with biopsies, but are still rare. ( 2017;1:841-851).
经证实为肝细胞癌（HCC）的肝脏肿块活检与肿瘤细胞种植于腹壁或胸壁的风险相关。文献报道的种植频率差异很大。我们在一个大型综合医疗保健系统中进行了一项回顾性队列研究，以检查由社区放射科医生进行靶向肝脏活检、消融或两者兼有的HCC患者的种植率。我们查阅了病理和放射学记录，以确定壁种植的发生情况，壁种植定义为沿明确或可能的针道出现的胸壁或腹壁病变。共有1015例患者接受了靶向肝脏活检（795例）、消融（72例）或两者兼而有之（148例）。284例患者（28%）接受了多种手术。确定了6例种植病例。如果仅进行活检，壁种植率为2/795例患者（0.13%；95%置信区间[CI]，0.00%-0.60%），而如果进行消融，壁种植率为4/220例（1.82%；95%CI，0.05%-3.58%）（P=0.01）。单独进行消融时，壁种植率为0/72例（0.00%；95%CI，0.00%-0.04%），如果两种手术都进行，壁种植率为4/148例（2.70%；95%CI，0.74%-6.78%）（P=0.31）。在有1年随访的患者中（n=441），如果仅进行活检，种植率为2/269例（0.74%；95%CI，0.00%-1.77%），如果进行消融，种植率为4/172例（2.33%；95%CI，0.07%-4.58%）。在所有病例中，种植均不是直接死因。：在社区环境中且作为唯一手术进行时，肝脏肿块活检的壁种植率较低。消融可能有较高的种植率，特别是与活检同时进行时，但仍然很少见。（2017；1：841-851）
