Bhattacharya S, Dhillon A P, Rees J, Savage K, Saada J, Burroughs A, Rolles K, Davidson B
University Department of Surgery, Royal Free Hospital and School of Medicine, London, England.
Hepatology. 1997 Mar;25(3):613-8. doi: 10.1002/hep.510250320.
Small hepatocellular carcinomas (HCCs) in cirrhotic livers are difficult to detect. This study aimed to assess if small HCCs can be better identified using specific macroscopic sampling criteria and Lipiodol (iodized oil) localization on radiographs, and to evaluate thereby their incidence and morphology. Prospective cirrhotic recipients of orthotopic liver transplantation (OLT) were administered hepatic arterial Lipiodol at angiography. Posttransplantation, the explant livers were sliced and inspected as per routine for unusual nodules. If unusual nodules were found or HCC clinically suspected, the slices underwent soft-tissue radiography. Tissue samples were then taken as per protocol from all nodules with diameter > or =1 cm/unusual appearance/exophytic bulge, and from foci of radiographic Lipiodol uptake or high soft-tissue density. One hundred three lesions were assessed and classified histologically as HCC (n = 55) or regenerative nodule (n = 39) or borderline (n = 9). Sampling according to predetermined macroscopic criteria proved an effective method for identifying small HCCs: 44 cancers were detected, most <5 mm in diameter, additional to those picked up on routine assessment. Green nodules were more likely to be HCC (P < .0001). The cancers were all multifocal, and had characteristic histological features of HCC except for 12 unusual fibrotic cancers in livers with alcoholic cirrhosis. Lipiodolization alone identified one additional HCC. Lipiodol retention on x-ray is fairly specific for HCC (83%), and can even identify lesions 2 mm in diameter. But its sensitivity is poor (45%), and its routine use to identify HCCs in explant livers is not recommended.
肝硬化肝脏中的小肝细胞癌（HCC）很难被检测到。本研究旨在评估使用特定的宏观取样标准和放射照片上的碘油（碘化油）定位是否能更好地识别小HCC，并据此评估其发病率和形态。对接受原位肝移植（OLT）的前瞻性肝硬化患者在血管造影时给予肝动脉碘油。移植后，将切除的肝脏切片并按常规检查有无异常结节。如果发现异常结节或临床怀疑为HCC，则对切片进行软组织放射摄影。然后按照方案从所有直径≥1 cm/外观异常/外生性隆起的结节以及放射照片上碘油摄取部位或软组织高密度灶中采集组织样本。对103个病变进行了评估，并组织学分类为HCC（n = 55）、再生结节（n = 39）或临界病变（n = 9）。根据预定的宏观标准进行取样被证明是识别小HCC的有效方法：除了在常规评估中发现的那些，还检测到44例癌症，大多数直径<5 mm。绿色结节更有可能是HCC（P <.0001）。这些癌症均为多灶性，除了酒精性肝硬化肝脏中的12例异常纤维化癌症外，都具有HCC的特征性组织学特征。单独使用碘油标记又发现了1例HCC。X线片上碘油滞留对HCC相当特异（83%），甚至可以识别直径2 mm的病变。但其敏感性较差（45%），不建议常规用于识别切除肝脏中的HCC。
