Kim Dong Wook, Kim So Yeon, Kang Hyo Jeong, Kang Ji Hun, Lee Seung Soo, Shim Ju Hyun, Choi Sang Hyun, Shin Yong Moon, Byun Jae Ho
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ultrasonography. 2021 Jul;40(3):387-397. doi: 10.14366/usg.20110. Epub 2020 Nov 3.
According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories.
A total of 145 High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results.
After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies.
In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.
根据美国肝病研究协会（AASLD）指南，活检是根据肝脏影像报告和数据系统（LI-RADS）分类对肝脏局灶性病变进行诊断的一种选择。我们根据LI-RADS分类评估了超声引导下粗针活检（CNB）的诊断性能。
回顾性纳入145例肝细胞癌（HCC）高危患者，这些患者术前接受了磁共振成像（MRI）检查，随后对肝脏局灶性病变进行了CNB。根据2018版LI-RADS对MRI上的肝脏局灶性病变进行评估。病理结果分为HCC、非HCC恶性肿瘤和良性病变。当CNB病理报告和手术病理报告一致时，分类被定义为正确。非诊断性结果被定义为CNB病理结果不足以进行特定诊断。计算每个LI-RADS分类中正确分类的比例，不包括非诊断性结果。
排除16例非诊断性结果后，分析了131个病变（45个LR-5、24个LR-4、4个LR-3和58个LR-M）。所有LR-5病变均为HCC，CNB正确分类了97.8%（44/45）的LR-5病变。CNB正确分类了所有24个LR-4病变，其中16.7%（4/24）为非HCC恶性肿瘤。所有LR-M病变均为恶性，62.1%（36/58）为非HCC恶性肿瘤。CNB正确分类了93.1%（54/58）的LR-M病变，CNB结果为HCC的病变中有12.5%（3/24）被确认为非HCC恶性肿瘤。
与AASLD指南一致，CNB对LR-4病变可能有帮助，但对LR-5病变则不必要。在LR-M病变中，CNB的HCC结果不能排除非HCC恶性肿瘤。
