超声引导细针抽吸活检对门静脉癌栓的鉴别诊断价值

目的　探讨超声引导细针抽吸活检对门静脉癌栓 (PVTT)的鉴别诊断价值。方法　对 2 2例原发性肝细胞癌 (HCC)伴发门静脉栓子 (PVT )及 8例肝硬化伴发PVT在超声引导下行细针穿刺抽吸活检 ,并对其中 8例门静脉分支充满型栓子行 18G自动组织切割活检。计算细针抽吸细胞学、组织学的阳性率并与自动活检阳性率进行比较。结果　细针抽吸活检细胞学、组织学阳性率分别为 93 .3 % ( 2 8/3 0 )和90 .0 % ( 2 7/3 0 ) ,与同部位自动活检阳性率 91.7% ( 11/12 )比较差异无显著性意义 ( P >0 .0 5 )。 2 2例HCC伴PVT抽吸活检肝细胞癌阳性 17例 ( 77.3 % ) ,组织学阳性 18例 ( 81.8% ) ,综合后 2 0例诊断为癌栓 ,余 2例为血栓。 8例肝硬化伴发PVT活检均未发现肝癌细胞和 (或 )组织。结论　超声引导门静脉栓子细针抽吸活检有较高的阳性率与诊断价值 ,且与自动活检阳性率无明显差异 ,因此对于彩色多普勒血流显像与脉冲多普勒诊断尚不明确的病例采用细针抽吸活检可达到早期明确诊断的目的。

Differential diagnosis value of ultrasound-guided fine needle aspiration biopsy in portal vein tumor thrombosis

Objective To probe the differential diagnosis value of ultrasound-guided fine needle biopsy in portal vein tumor thrombosis(PVTT). Methods Twenty-two hepatocellular carcinoma (HCC) patients with portal vein thrombosis(PVT) and 8 hepatocirrhosis patients with PVT were studied by ultrasound-guided fine needle aspiration biopsy and 8 PVT filling portal vein embranchment of 30 PVT were examined by 18G automatic biopsy. The positive rates of aspiration biopsy cytology and histology were calculated and compared with that of automatic biopsy. Results The positive rates of fine needle aspiration biopsy cytology and histology were 93.3%(28/30) and 90.0%(27/30), respectively, and were not different markedly from that of automatic biopsy which was 91.7%(11/12). HCC cells were positive in 17 PVT ( 77.3%) and histology was positive in 18 PVT in aspiration biopsy. In total, twenty tumor thrombi were diagnosed. The other two were diagnosed as benign thrombosis. No HCC cells and/or tissue were observed in 8 hepatocirrhosis with PVT. Conclusions Ultrasound-guided fine needle biopsy in PVTT has comparable high positive rate and diagnosis value and its positive rate is not different from automatic biopsy apparently. So the cases that are not diagnosed by color Doppler and pulsed Doppler can be diagnosed early by ultrasound-guided fine needle aspiration biopsy.