Dusenbery D, Dodd G D, Carr B I
Department of Pathology, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Cancer. 1995 Apr 15;75(8):2057-62. doi: 10.1002/1097-0142(19950415)75:8<2057::aid-cncr2820750805>3.0.co;2-k.
Detection of portal vein tumor invasion in patients with hepatocellular carcinoma (HCC) is important in determining therapy and prognosis. Fine-needle aspiration (FNA) of a portal vein thrombus under ultrasound guidance facilitates the distinction of malignant from benign thrombus without resorting to laparotomy. In this study, the FNA findings of 46 patients who underwent this procedure are described.
Cytologic findings of 48 aspirations from 46 patients who underwent percutaneous ultrasound-guided portal vein FNA were reviewed.
Twenty-nine of the 46 patients had a prior or concurrent biopsy-confirmed diagnosis of HCC at the time of portal vein FNA. On cytologic review, 39 of the aspirates were positive for malignancy, 6 were negative, and 3 were suspicious. Histologic follow-up of three of the six patients with negative aspirates confirmed bland thrombi in their portal veins. No complications resulted from the FNA procedure. Of the 39 aspirates positive for HCC, 22 were well differentiated, 5 were well to moderately differentiated, 9 were moderately differentiated, and 3 were poorly differentiated. In all except the poorly differentiated tumors, a trabecular cellular arrangement was detected in either smears or cell blocks. The cytologic findings in these aspirates, in general, mirror those found in aspirates of HCC in the liver proper.
Portal vein FNA is an effective, well tolerated method for disease staging of patients with HCC. When used as the initial diagnostic procedure, in selected patients, it can provide the diagnosis and staging information simultaneously.
肝细胞癌（HCC）患者门静脉肿瘤侵犯的检测对于确定治疗方案和预后至关重要。超声引导下门静脉血栓细针穿刺抽吸（FNA）有助于区分恶性血栓和良性血栓，而无需进行剖腹手术。在本研究中，描述了46例行此操作患者的FNA结果。
回顾了46例行经皮超声引导门静脉FNA患者的48次抽吸的细胞学结果。
46例患者中有29例在门静脉FNA时已有活检确诊的HCC或同时确诊。经细胞学检查，39次抽吸结果为恶性阳性，6次为阴性，3次为可疑。6例抽吸结果为阴性的患者中有3例的组织学随访证实其门静脉内为单纯血栓。FNA操作未导致任何并发症。在39例HCC阳性抽吸物中，22例为高分化，5例为高分化至中分化，9例为中分化，3例为低分化。除低分化肿瘤外，在涂片或细胞块中均检测到小梁状细胞排列。这些抽吸物的细胞学结果总体上与肝内HCC抽吸物的结果相似。
门静脉FNA是一种有效的、耐受性良好的HCC患者疾病分期方法。在特定患者中，当用作初始诊断程序时，它可以同时提供诊断和分期信息。
