中国肝癌的治疗现状.ppt.pptVIP

* 14 Diagnosis of Hepatic Nodules 20 mm or Smaller in Cirrhosis Prospective Validation of the Noninvasive Diagnostic Criteria for Hepatocellular Carcinoma Alejandro Forner,1 Ram′on Vilana,2 Carmen Ayuso,2 Llu?′s Bianchi,2 Manel Sol′e,3 Juan Ram′on Ayuso,2 Loreto Boix,1 Margarita Sala,1 Mar?′a Varela,1 Josep M. Llovet,1,4 Concepci ′o Br′ u,2 and Jordi Bruix1 This study prospectively evaluates the accuracy of contrast-enhanced ultrasound (CEUS) and dynamic magnetic resonance imaging (MRI) for the diagnosis of nodules 20 mm or smaller detected during ultrasound (US) surveillance. We included 89 patients with cirrhosis [median age, 65 years; male 53, hepatitis C virus 68, Child-Pugh A 80] without prior hepatocellular carcinoma (HCC) in whom US detected a small solitary nodule (mean diameter, 14 mm). Hepatic MRI, CEUS, and fine-needle biopsy (gold standard) (FNB) were performed at baseline. Non-HCC cases were followed (median 23 months) by CEUS/3 months and MRI/6 months. FNB was repeated up to 3 times and on detection of change in aspect/size. Intense arterial contrast uptake followed by washout in the delayed/venous phase was registered as conclusive for HCC. Final diagnoses were: HCC (n 60), cholangiocarcinoma (n 1), and benign lesions (regenerative/dysplastic nodule, hemangioma, focal nodular hyperplasia) (n28). Sex, cirrhosis cause, liver function, and alpha-fetoprotein (AFP) levels were similar between HCC and non- HCC groups. HCC patients were older and their nodules significantly larger (P0.0001). First biopsy was positive in 42 of 60 HCC patients. Sensitivity, specificity, and positive and negative predictive values of conclusive profile were 61.7%, 96.6%, 97.4%, and 54.9%, for MRI, 51.7%, 93.1%, 93.9%, and 50.9%, for CEUS. Values for coincidental conclusive findings in both techniques were 33.3%, 100%, 100%, and 42%. Thus, diagnosis of HCC 20 mm or smaller can be established without a positive biopsy if both CEUS and MRI are conclusive. However, sensitivity o