Jenkins D, Gilmore I T, Doel C, Gallivan S
Department of Pathology, Queen's Medical Centre, Nottingham, UK.
QJM. 1995 Nov;88(11):819-25.
In a National Audit of 1500 liver biopsies, 38% were for suspected malignancy. To measure their contribution to clinical decisions, the initial diagnoses, biopsy diagnoses, final diagnoses, and outcomes were coded by computer and compared. Most patients (92%) were investigated for advanced malignancy. The accuracy of clinical diagnosis was 78% against final diagnosis. Liver biopsy was seen as 'confirming' clinical diagnosis overall. This was achieved in 67% (75% with ultrasound guidance), and specificity was almost 100%. However, hepatocellular cancer was confirmed by biopsy in only 32% and haematological malignancy in 13% of suspected cases. Within 3 months, 44% of patients with histological malignancy had died. Histological tumour type was not used in 36% of final diagnoses. Of patients with a malignancy-negative liver biopsy--showing reactive hepatitis, normality, or cholangitis/cholestasis--25%, 47% and 60%, respectively, had final malignant diagnoses. In 6% of patients, biopsy showed chronic liver disease. Only 12% of deaths were autopsied. Liver biopsy contributes very high specificity to the diagnosis of malignancy, and detects non-malignant disease. Failure to use tumour type may result in sub-optimal therapy. Improving diagnostic practice requires more information on outcomes, including autopsies.
在一项对1500例肝脏活检的全国性审计中，38%的活检是针对疑似恶性肿瘤。为衡量其对临床决策的贡献，对初始诊断、活检诊断、最终诊断及结果进行计算机编码并比较。大多数患者（92%）因晚期恶性肿瘤接受检查。临床诊断相对于最终诊断的准确率为78%。肝脏活检总体上被视为“证实”临床诊断。这在67%的病例中得以实现（超声引导下为75%），特异性几乎为100%。然而，在疑似病例中，仅32%的肝细胞癌和13%的血液系统恶性肿瘤通过活检得到证实。在3个月内，44%的组织学确诊恶性肿瘤患者死亡。36%的最终诊断未采用组织学肿瘤类型。在肝脏活检为恶性阴性的患者中——显示反应性肝炎、正常或胆管炎/胆汁淤积——分别有25%、47%和60%最终被诊断为恶性肿瘤。6%的患者活检显示为慢性肝病。仅12%的死亡病例进行了尸检。肝脏活检对恶性肿瘤诊断具有很高的特异性，并能检测出非恶性疾病。未采用肿瘤类型可能导致治疗欠佳。改进诊断实践需要更多关于结果的信息，包括尸检信息。
