Navarro F, Taourel P, Michel J, Perney P, Fabre J M, Blanc F, Domergue J
Département de Transplantation Hépatique, Service de Chirurgie Digestive C, Montpellier, France.
Liver. 1998 Aug;18(4):251-4. doi: 10.1111/j.1600-0676.1998.tb00161.x.
AIMS/BACKGROUND: We report the discovery of associated metastatic subcutaneous and metastatic diaphragmatic nodules on the needle track after fine-needle biopsy aspiration under echography, which has not yet been reported in the literature.
A 35-year-old man with non-replicating hepatitis B virus presented with a tumor that suggested hepatocarcinoma with cirrhosis. A diagnostic needle biopsy was carried out before surgery. Twelve months later, he presented with a series of four continuous metastatic diaphragmatic nodules on the inner wall lining the needle track. Surgery was performed, followed by external radiation (40 Gy).
The risk of seeding following fine-needle biopsy aspiration of hepatocellular carcinoma can no longer be considered negligable. The real risk is probably underestimated. Even for biopsy of lesions localized to the inferior part of the liver, diaphragmatic seeding is possible. This seeding necessitates surgical resection, increasing the therapeutic morbidity of hepatocellular carcinomas. We believe that in cases where investigation of a small hepatic tumor suggests a hepatocellular carcinoma that could be resected, or for candidate patients for liver transplantation. one should not puncture the tumor. If this diagnostic biopsy is essential, then the needle track could be resected upon surgery, after cutaneous external tattooing.
目的/背景：我们报告了在超声引导下细针穿刺活检抽吸后，针道上出现转移性皮下结节和转移性膈肌结节的情况，这在文献中尚未有报道。
一名35岁的乙肝病毒携带者出现了提示肝硬化合并肝癌的肿瘤。术前进行了诊断性针吸活检。12个月后，他在针道内壁出现了一系列连续的4个转移性膈肌结节。进行了手术，随后进行了外照射（40 Gy）。
肝细胞癌细针穿刺活检抽吸后的种植风险不能再被视为可忽略不计。实际风险可能被低估了。即使是对局限于肝脏下部的病变进行活检，也可能发生膈肌种植。这种种植需要手术切除，增加了肝细胞癌的治疗并发症。我们认为，在对小肝肿瘤进行检查提示可能为可切除的肝细胞癌的情况下，或者对于肝移植候选患者，不应穿刺肿瘤。如果这种诊断性活检必不可少，那么在手术时可在皮肤外部标记后切除针道。
