超声造影界定肝癌浸润范围的应用价值  

Identification the invasion range of hepatocellular carcinoma by contrast-enhanced ultrasound

作　　者：曾燕荣[1] 陈敏华[1] 严昆[1] 廖盛日[1] 戴莹[1] 杨薇[1] 李吉友[1] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院超声科,100036

出　　处：《中华医学杂志》2006年第46期3294-3298,共5页National Medical Journal of China

基　　金：北京市重大项目培育专项基金资助项目(Z0005190040431);北京大学医学部"十五""211工程"重点学科建设项目经费资助(523)

摘　　要：目的研究肝细胞型肝癌(HCC)在超声造影(CEUS)动脉期至门脉期增强范围变化的病理意义,探讨CEUS对界定肝细胞型肝癌边界浸润范围的应用价值。方法41例手术切除,11例超声引导穿刺病理证实的肝细胞型肝癌共52例52个病灶,手术或穿刺前行常规超声(US)及CEUS检查,比较肿瘤大小、边界、形态变化;设CEUS癌灶边界增强范围增大或更不规则增强为A组,边界形态未改变为B组。对肿瘤边缘交界区组织(瘤周组织)取病理标本,行HE染色、CD34免疫组化染色,检测其病理学特征和微血供状况,进行对比研究。结果52个肝细胞型肝癌灶A组占32灶(61·54%),其中75%(24灶)US示肿瘤边界不清;B组20灶中40%(8灶)US示边界不清晰(P<0·05)。A、B两组肿瘤最大径均值分别为(6·1±2·9)cm及(4·4±2·1)cm(P<0·05)。分析41个手术切除肝细胞型肝癌标本,A组25灶计75张病理切片中88%(66张)显示瘤周癌细胞呈浸润性生长,显著高于B组16灶中的56·3%(27/48张,P<0·001);52灶肝细胞型肝癌经CD34免疫组化染色显示A组瘤周微血管密度(MVD)显著高于B组(52·25vs36·82,P<0·01)。结论CEUS肝细胞型肝癌增强范围增大与肿瘤边界清晰度密切相关,肿瘤边缘增大的增强区域内癌细胞浸润及微血管生成增多,反映了癌组织浸润性生长的病理学特性。CEUS有助于界定肝细胞型肝癌边界大小及浸润范围,可为局部治疗提供参考依据。Objective To study the histopathologic characteristics of the enlarged enhancement area of hepatocellular carcinoma （HCC） at contrast-enhanced ultrasound （CEUS） during the arterial or portal phase and evaluate the value of CEUS in identifying the invasion range of HCC. Methods Fifty-two patients with fifty-two lesions confirmed as HCC pathologically （41 by surgery and 11 by needle biopsy） were included. The lesion size, margin and shape at fundamental uhrasonography （US） and CEUS were compared before surgery or needle biopsy. Lesions with a larger enhancement area and/or a more irregular shape during the arterial or portal phase at CEUS were classified as group A; lesions with unchanged size and shape were classified as group B. The tissues specimens of the tumor margin （ peripheral tumor tissues ） were obtained and the slides were stained with HE and CD34 immunohistochemistry, the histopathology and microvessels density （MVD） of group A and B were compared. Results In group A, 75% （24/32 lesions） had vaguely demarcated margin at US compared with 40% （8/20 lesions） in Group B （P 〈0. 05 ）. The largest average diameter of Group A was 6. 1 ±2.9 cm compared with 4.4 ±2. lcm in group B （P〈 0. 05）. Of the 41 surgically resected HCC specimens, 88% of the 75 slides for the 25 lesions in Group A demonstrated cancer cells invasion in the peripheral tumor, much higher than the 56. 3% （27/48 slides） of the 16 lesions in Group B （ P 〈 0. 001 ）. The MVD in Group A by CD34 immunohistochemistry was significant higher than that in Group B （ 52. 25 vs 36.82, P 〈 0.01 ） . Conclusion The enlarged enhancement area of HCC at CEUS correlated with the sharpness of tumor margins. The cancer cells invasion and more microvessels generation in the enlarged enhancement area reflected the histopathologic characteristics of invasive growth pattern of HCC. CEUS is helpful in identifying the actual tumor size and invasion range, and might be helpful for HCC treatment.

关 键 词：肝肿瘤 超声检查 

分 类 号：R735.7[医药卫生—肿瘤]