Caturelli E, Bisceglia M, Fusilli S, Squillante M M, Castelvetere M, Siena D A
Divisione di Gastroenterologia and Servizio di Anatomia e Istologia Patologica, Casa Sollievo della Sofferenza IRCCS, Foggia, Italy.
Dig Dis Sci. 1996 Dec;41(12):2326-31. doi: 10.1007/BF02100122.
There is still debate over the relative merits of cytology and histology in diagnosing hepatocellular carcinoma in cirrhotic livers. Previous comparisons of the diagnostic accuracies of these two methods may have been biased by sampling errors due to multiple punctures. We compared the diagnostic accuracies of cytology and microhistology using tissue and cells from the same point in liver nodules subsequently proved to be hepatocellular carcinoma. A single ultrasound-guided liver-nodule biopsy was obtained with a 20- to 21-G cutting needle from 131 cirrhotic patients. The solid portion of samples was used for microhistology; the remainder was subjected to smear cytology. The results of each type of examination were expressed as true positive, nonspecific malignancy, false negative, or inadequate for diagnosis. No false-positive diagnoses were made in 13 benign lesions. In 118 HCC nodules (particularly those <30 mm in diameter), cytology provided a significantly higher percentage of correct diagnoses (85.6%) that was only slightly inferior to that based on results of both studies (89.8%). The single-biopsy technique generally provides adequate tissue for histology and cytology specimens with a high cellularity. It reduces both the cost and the risks of fine-needle biopsy diagnosis of hepatocellular carcinoma.
在肝硬化肝脏中，细胞学和组织学在诊断肝细胞癌方面的相对优势仍存在争议。以往对这两种方法诊断准确性的比较可能因多次穿刺导致的抽样误差而存在偏差。我们使用随后被证实为肝细胞癌的肝结节中同一点的组织和细胞，比较了细胞学和微组织学的诊断准确性。用20至21G切割针在超声引导下对131例肝硬化患者进行单次肝结节活检。样本的实性部分用于微组织学检查；其余部分进行涂片细胞学检查。每种检查结果分为真阳性、非特异性恶性、假阴性或诊断不充分。13个良性病变均未出现假阳性诊断。在118个肝癌结节（尤其是直径<30mm的结节）中，细胞学诊断的正确百分比显著更高（85.6%），仅略低于两项研究结果综合得出的诊断率（89.8%）。单次活检技术通常能为组织学和细胞学标本提供足够的组织，且细胞含量高。它降低了肝细胞癌细针穿刺活检诊断的成本和风险。
