超声造影在肝脏恶性肿瘤活检假阴性病例分析中的应用价值

目的探讨超声造影引导肝脏恶性肿瘤经皮穿刺活检的临床应用价值.方法超声引导下对287例患者342灶肝脏占位病变行穿刺活检,病理组织学诊断为恶性肿瘤203例238灶、未见恶性84例104灶.未见恶性病灶中增强CT、MRI、血管造影或肿瘤标志物等检查可疑恶性或不能排除恶性的22例肝占位病变者为本文研究对象.采用造影剂SonoVue行灰阶超声造影引导再次穿刺活检.病变大小0.8～13.2cm,平均3.4cm.穿刺活检采用21～18G手动抽吸活检针或自动活检针,标本送病理科行组织学和细胞学检查.取材量满足病理诊断为取材成功.结果22例肝占位病变平均穿刺次数1.7次(38/22),取材成功率为100%.21例病理组织学诊断为恶性病变,为首次常规超声引导穿刺活检假阴性病例,1例穿刺活检病理结果仍为阴性排除恶性.恶性肿瘤首次常规超声引导穿刺活检假阴性率为9.4%(21/224).穿刺病理最终诊断结果为增生结节合并癌变5例,肝癌合并变性坏死7例,肝转移癌坏死及微小灶4例,手术或介入治疗后残留或新生5例.本组无1例并发症发生.结论超声造影可确认恶性肿瘤的活性区域、变性或坏死区域以及微小恶性肿瘤;超声造影引导穿刺活检可有效提高经皮穿刺活检的确诊率、降低常规超声引导穿刺活检的假阴性率,其临床应用价值应予以重视.

Analysis of false negative in malignant liver tumor biopsies―importance of contrast-enhanced ultrasound

Objective To evaluate the clinical utility of contrast-enhanced ultrasound in percutaneous liver biopsies of malignant liver lesions. Methods Two hundred and eighty-seven patients with 342 unconfirmed focal liver lesions underwent percutaneous liver biopsy guided by ultrasound. Two hundred and three cases with 238 lesions were diagnosed as malignant, and 84 cases with 104 lesions were not found malignant. In 22 cases malignancy could not be excluded clinically due to the results from tumor markers, CT, MRI or angiography. They were analyzed in this study. We performed CEUS prior to the repeated biopsies in order to better localize the biopsy site. Among them, there were 15 males and 7 females, age 35~76 years (mean 53.4 years). Biopsy was performed using a 21~18 gauge manual aspiration needle or automatic cutting needle. The specimens were examined for histologic and cytologic analysis by 2 experienced pathologists. The specimen which was satisfied for histologic and cytologic examination was considered successful. Results The average puncture procedures in 22 cases was 1.7 (38/22) and the successful rate was 100%, 21 cases were diagnosed as malignancy and 1 case was not found malignancy in pathology and malignancy was excluded. The 21 cases were false negative cases. The false negative rate of malignant liver tumors in the first biopsy procedure guided by conventional ultrasound was 9.4% (21/224). The definite results of pathological diagnosis were 5 cases of hyperplasia with malignant degradation, 7 cases of HCC with degeneration and necrosis, 4 cases of metastases with necrosis or minute lesions and 5 cases with residual or renascent foci after surgery or interventional therapy. No complications occurred in our study. Conclusions CEUS can identify the active area, denaturalization or necrosis area of malignant lesions and minute tumors, which will significantly increase the accurate diagnostic rate of biopsy and decrease the false negative rate. The clinical application of CEUS should be appreciated.