2528例原发性肝癌细针穿刺细胞学检查及其并发症  

Evaluation of the results of fine-needle aspiration liver biopsies and the complications in 2528 cases

作　　者：王鹏[1] 刘鲁明[1] 孟志强[1] 陈震[1] 林钧华[1] 周振华[1] 陈颢[1] 王琨[1] 平波[2] 王龙富[2] 王柏华[3] 黄雅芳[3] 

机构地区：[1]复旦大学上海医学院肿瘤学系、复旦大学附属肿瘤医院中西医结合科,上海200032 [2]复旦大学上海医学院肿瘤学系、复旦大学附属肿瘤医院病理科,上海200032 [3]复旦大学上海医学院肿瘤学系、复旦大学附属肿瘤医院超声诊断科,上海200032

出　　处：《中华肝脏病杂志》2007年第10期758-762,共5页Chinese Journal of Hepatology

摘　　要：目的评价超声引导细针穿刺在原发性肝癌诊断中的价值及其相关并发症。方法回顾性分析1985年6月1日至2005年5月31日复旦大学附属肿瘤医院2528例临床疑诊原发性肝癌患者肝穿刺细胞学检查及随访结果。结果经肝穿刺细胞学证实为恶性肿瘤者2061例（81.53%,其中肝脏原发肿瘤1704例,转移性肿瘤41例,原发不明恶性肿瘤316例）、阴性431例（17.05%）、疑癌或异形36例（1.42%）。临床随访发现2061例恶性患者最终均被证实为恶性肿瘤;431例阴性中,37.82%（163/431）最终被证实为恶性（其中原发性肝癌136例）;36例疑癌或异形中,28例最终被证实为恶性（均为原发性肝癌）。946例AFP≥400μg/L患者全部证实为恶性,其中原发性肝癌942例、肝母细胞瘤1例、转移性肝癌3例。AFP〈400μg/L的1582例患者中,最终诊断原发性肝癌1154例,其中81.89%（945例）可通过肝穿刺直接确诊。本研究结果显示,细针穿刺细胞学检查用于肝脏肿瘤定性诊断（良、恶性鉴别）敏感性91.52%、特异性100.00%、阳性预测值100.00%、阴性预测值59.10%,总准确性为92.44%。肝穿刺可直接确诊原发性肝癌达81.01%。77.49%的患者可通过肝穿刺明确原发或继发。穿刺后并发症主要为：出血11例（0.44%）,针道种植转移5例（0.2%）。结论经皮细针穿刺细胞学检查可有效确定肝脏肿瘤的性质,且对原发性肝癌诊断准确性高。穿刺相关并发症发生少,易于推广。Objective To study the value of fine-needle aspiration biopsy （FNAB） in diagnosing primary liver cancer （PLC） and its major complications. Methods From June 1, 1985 to May 31, 2005, 2528 patients who were presented with suspected PLC underwent ultrasound-guided FNAB in the Cancer Hospital of Fudan University. The results were retrospectively reviewed. Results Of those 2528 cases, there was malignancy in 2061 patients （81.53%）, of which 1704 were diagnosed as primary liver neoplasms; 41 were diagnosed as metastatic carcinoma, and 316 were not further classified as primary or metastatic. No malignancy was found in 431 cases （17.05%）. In 36 cases （1.42%）, suspicious malignancy or anaplasia was suggested. Follow-up results showed that all the 2061 positive cases were verified to be malignant and there were no false positive cases. 163 of the 431 negative cases were verified to be malignant in the follow-ups, of which 136 cases were PLC; 28 of the 36 suspicious malignancy or anaplasia were proven to be malignant （all were PLC）. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of our FNAB for diagnosing liver malignancy were 91.52%, 100.00%, 100.00%, 59.10% and 92.44%,respectively, and 81.01% cases were diagnosed by FNAB in all the 2096 cases with PLC. Cytological examinations of the smears obtained by FNAB correctly distinguished primary and secondary malignancy in 77.49% of the patients. After FNAB, 11 patients （0.44%） had intraperitoneal hemorrhages and 5 cases （0.20%） had needle tract implantation metastases. Conclusions FNAB is important and effective for determining the malignancy potential of liver tumors, especially for PLC. Complications related to FNA were rather rare, therefore, this technique may be easily applied to clinical practice.

关 键 词：癌 肝细胞 诊断 活检 细针穿刺 并发症 

分 类 号：R686[医药卫生—骨科学]