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本帖最后由 风雨不动 于 2012-4-14 15:23 编辑
<http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02529.x/abstract>
Noninvasive diagnostic criteria for hepatocellular carcinoma in hepatic
masses >2 cm in a hepatitis B virus-endemic area
Sung Eun Kim1, Han Chu Lee1, Ju Hyun Shim1, Hyun Joo Park1, Kang Mo Kim1,
Pyo Nyun Kim2, Yong Moon Shin2, Eun Sil Yu3, Young-Hwa Chung1, Dong Jin
Suh1Article first published online: 11 APR 2011
DOI: 10.1111/j.1478-3231.2011.02529.x
© 2011 John Wiley & Sons A/S
Issue
Liver International
Early View (Online Version of Record published before inclusion in an
issue)
Abstract
Background: Noninvasive criteria for diagnosing hepatocellular carcinoma
(HCC) suggested by the American Association for the Study of Liver Diseases
(AASLD) in 2005 consisted of serum α-fetoprotein (AFP) level >200 ng/ml or
a typical enhancement pattern (arterial enhancement and portal/delayed
washed out) on dynamic imaging of hepatic mass(es) >2 cm in a cirrhotic
liver.
Aims: To validate these criteria in a Korean population and to evaluate
whether these criteria are applicable to patients without cirrhosis at a
high risk of developing HCC.
Methods: We prospectively investigated 206 consecutive patients with
hepatic mass(es) >2 cm who underwent biopsy or surgical resection. Patients
were evaluated by four-phase dynamic computed tomography (CT) and by assays
of serum AFP concentrations at baseline. Patients were classified according
to the presence of risk factors or cirrhosis, and the diagnostic accuracy
of each test was determined.
Results: The positive predictive values (PPV) of typical CT findings or
serum AFP >200 ng/ml were 97.8% in cirrhotic patients, 89.6% in high-risk
patients without cirrhosis and 82.4% in low-risk patients. The PPVs of
typical CT findings alone in these groups were 98.8, 97.6 and 87.5%
respectively. In high-risk patients without cirrhosis, the addition of
serum AFP levels to typical CT findings minimally increased the diagnostic
sensitivity from 81.6 to 87.8% but reduced the PPV from 97.6 to 89.6%.
Conclusions: Serum AFP concentration is not a suitable diagnostic criterion
for HCC. Typical CT findings can be used to diagnose HCC >2 cm both in
cirrhotic patients and in high-risk patients without cirrhosis.
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发表于 2011-4-13 11:35
