肝细胞癌超声造影增强范围病理意义的探讨

目的 探讨肝细胞癌超声造影增强范围较常规超声测值增大的病理学意义.方法 35例肝细胞癌患者手术前进行常规超声和超声造影检查,比较常规超声、超声造影及手术后肿瘤大小,显微镜下观察肝细胞癌边缘癌细胞浸润深度,分析比较超声造影增强范围较常规超声测值增大的组织病理学特征.结果 35例肝细胞癌中14例(40%)超声造影增强范围较常规超声测值增大,9例肝细胞癌增大区域为癌细胞浸润,2例为瘤周脂肪变性伴炎细胞浸润,2例瘤周腺瘤样增生伴炎细胞,1例瘤周炎细胞伴肝内多发肝细胞癌.以超声造影增强 范围较常规超声测值增大作为肝细胞癌局部浸润的诊断标准,超声造影诊断肝细胞癌局部浸润的敏感性为90%,特异性为80%,准确性为82.9%,阳性预测值为64.3%,阴性预测值为95.2%.结论 与常规超声比较,超声造影判断肝细胞癌局部浸润范围更准确.

Pathological characteristic of enlarged area of hepatocellular carcinoma on contrast enhanced ultrasonography

Objective To explore pathological characterization of the enlarged contrast enhanced area of hepatocellular carcinoma ( HCC) on contrast enhanced ultrasonography ( CEUS). Methods Thirty-five HCC patients underwent conventional ultrasonography and CEUS before hepatectomy. The tumor sizes were measured on conventional ultrasonography,CEUS and postoperative resected specimen at the largest section. The infiltration depth of the HCC was observed under microscope in the peripheral area of the tumors. HCC with the size of contrast enhancement area on CEUS 0. 3 cm larger than that on conventional ultrasonography was defined as group A, and the others as group B. The pathological character of the tumor and tissues surrounding the tumor were analyzed and compared between the two groups. Results Among 35 HCC, 40% (14/35) HCC increased in size on CEUS compared with ultrasonography. Of them,9 tumors with increased area on CEUS were confirmed to be invasive HCC on pathology. Using the enlarged contrast enhanced area on CEUS as the diagnostic criteria of invasive HCC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 90%, 80%, 82.9%, 64.3%, 95. 2%, respectively. Conclusions The contrast enhanced area on CEUS can reflect the infiltrative tumor size more accurately compared with conventional ultrasonography.