Ceriani Roberto, Colapietro Francesca, Gabbiadini Roberto, Buono Arianna Dal, Pugliese Nicola, Masetti Chiara, Brandaleone Luca, Ierace Tiziana, Solbiati Luigi
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy.
J Ultrasound. 2024 Nov 2. doi: 10.1007/s40477-024-00949-x.
In cases of perihilar focal liver lesions, distinguishing between benign strictures and malignancies is critical to prevent unnecessary surgery. Although the use of contrast-enhanced CT or MRI in combination with clinical and laboratory findings can aid in diagnosis, histologic examination is often necessary. Histologic specimens can be obtained through various techniques, including ERCP-guided brush cytology or intraductal biopsy, cholangioscopy-directed biopsy or endoscopic ultrasound (EUS). However, these methods have been associated with suboptimal sensitivity and specificity, sometimes leading to inconclusive results. Therefore, ultrasound-guided percutaneous biopsy (US-guided PB) may play a crucial role, but data is lacking for perihilar lesions. The objective of our study was to assess the technical feasibility and safety of US-guided PB for perihilar lesions.
We included 20 consecutive patients who underwent US-guided PB of perihilar liver lesions that were not suitable for surgery between June 2018 and October 2023.
All samples were obtained using a Menghini needle 20G and were adequate for histological examination, with a mean diameter of 12.3 mm (range 3-40 mm). Out of the 20 patients, 11 were diagnosed with malignancy while the remaining 9 had inflammatory or fibrotic tissue samples. No adverse events related to the procedure were reported.
US-guided PB of perihilar liver lesions is a valuable and safe diagnostic approach to consider for patients who are not suitable for surgery.
在肝门周围局灶性肝病变的病例中，区分良性狭窄和恶性肿瘤对于避免不必要的手术至关重要。尽管使用对比增强CT或MRI并结合临床和实验室检查结果有助于诊断，但组织学检查往往是必要的。组织学标本可通过多种技术获取，包括内镜逆行胰胆管造影（ERCP）引导下的刷检细胞学或导管内活检、胆管镜引导下活检或内镜超声（EUS）。然而，这些方法的敏感性和特异性并不理想，有时会导致结果不明确。因此，超声引导下经皮活检（US引导下PB）可能发挥关键作用，但对于肝门周围病变的数据尚缺乏。我们研究的目的是评估US引导下PB对肝门周围病变的技术可行性和安全性。
我们纳入了2018年6月至2023年10月期间连续20例接受US引导下PB的肝门周围肝病变患者，这些病变均不适合手术。
所有样本均使用20G Menghini针获取，足以进行组织学检查，平均直径为12.3mm（范围3 - 40mm）。20例患者中，11例被诊断为恶性肿瘤，其余9例有炎症或纤维化组织样本。未报告与该操作相关的不良事件。
对于不适合手术的患者，US引导下对肝门周围肝病变进行PB是一种有价值且安全的诊断方法。
