超声造影联合血清CA19-9鉴别诊断胆管细胞癌与肝细胞癌应用研究

doi:10.3969/j.issn.1672-5069.2021.06.034

摘要/Abstract

摘要： 目的探讨肝内胆管细胞癌(ICC)与肝细胞癌(HCC)患者超声造影(CEUS)和血清糖类抗原19-9(CA19-9)水平变化特征。方法经组织病理学检查诊断的ICC患者48例和HCC患者78例,进行CEUS检查,常规检测血清CA19-9。建立鉴别诊断ICC与HCC的多指标二元Logistic回归方程,探索其诊断ICC的价值。结果 45.8%ICC患者以肿瘤周围环状增强为主,显著高于HCC患者的2.6%(P<0.05);58.3%ICC患者造影剂显著廓清,而94.9% HCC呈弱或无廓清(P <0.05);ICC组廓清时间为(54.6±10.2)s,显著早于HCC组【(76.1±25.1)s,P <0.05】;72.9%ICC患者血清CA19-9升高,显著高于HCC组的19.2%(P<0.05);建立多指标联合的二元Logistic诊断模型方程为:Logit(P)=-4.030+2.640×增强模式+2.486×廓清时间+2.579×廓清程度+2.731×血清CA19-9 (U/ml),该模型识别ICC的AUC为0.943,其敏感度和特异度分别为79.2%和93.6%。结论熟悉ICC与HCC的超声造影表现特征,结合血清CA19-9水平,可以帮助鉴别这两种肿瘤。

关键词: 胆管上皮癌, 肝细胞癌, 超声造影, 血清糖类抗原19-9, 诊断

Abstract: Objective The aim of this study was to evaluate the value of contrast-enhanced ultrasound (CEUS) and serum carbohydrate antigen (Ca19-9) levels in differential diagnosis of patients with intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 48 patients with histopathological confirmed ICC and 78 patients with histopathological confirmed HCC were enrolled in this study, and all underwent CEUS and serum CA19-9 levels were detected. A binary Logistic regression model was established for the differential diagnosis of ICC and HCC. Results 45.8% ICC patients had peripheral rim enhancement of tumors at CEUS, significantly higher than 2.6% in HCC patients (P <0.05); the marked washout was found in 58.3% of ICC patients,However, 94.9% HCC patients were weak or not washout (P <0.05); the washout time in ICC group was(54.6±10.2)s, significantly earlier than (76.1±25.1)s in HCC group (P <0.05); 72.9% ICC patients had increased serum CA19-9 levels, significantly higher than 19.2% in HCC group (P<0.05); a binary Logistic diagnostic model equation was established: e.g. Logit(P)=-4.030+2.640×enhancement mode +2.486×washout time +2.579×washout degree +2.731×CA19-9 (u/ml), and the AUC was 0.943, with the sensitivity and specificity of 79.2% and 93.6% (P<0.05) in diagnosing ICC by this equation. Conclusion Compared with the diagnostic effect of a single indicator, logistic regression analysis based multi-indicator combined differential diagnosis of ICC and HCC has higher diagnostic value.

Key words: Intrahepatic cholangiocarcinoma, Hepatocellular carcinoma, Contrast-enhanced ultrasound, Carbohydrate antigen 19-9, Diagnosis

吴慧娟, 何年安, 谢蠡, 叶显俊, 章生龙, 刘力. 超声造影联合血清CA19-9鉴别诊断胆管细胞癌与肝细胞癌应用研究[J]. 实用肝脏病杂志, 2021, 24(6): 903-906.

Wu Huijuan, He Nian'an, Xie Li, et al. Contrast-enhanced ultrasonography and serum CA19-9 levels in differential diagnosis of patients with intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2021, 24(6): 903-906.

参考文献

[1] Huang JY, Li JW, Ling WW, et al. Can contrast enhanced ultrasound differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma? World J Gastroenterol,2020,26(27):3938-3951.
[2] 中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗规范(2019年版).中华消化外科杂志,2020,19(1):1-20.
[3] 梁霄,陶力野.肝内胆管细胞癌的精准治疗.中华肝胆外科杂志,2020,26(2):151-154.
[4] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin,2016,66(2):115-132.
[5] Omata M, Cheng AL, Kokudo N, et al. Asia-pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int,2017,11(4):317-370.
[6] Vilana R, Forner A, Bianchi L, et al. Intrahepatic peripheral cholangiocarcinoma in cirrhosispatients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology,2010,51(6):2020-2029.
[7] ChenLD, Ruan SM, Liang JY, et al.Differentiation of intrahepatic cholangiocarcinoma from hepatocellular carcinoma in high-risk patients: a predictive model using contrast-enhanced ultrasound. World J Gastroenterol,2018,24(33):3786-3798.
[8] Li F, Li Q, Liu Y, et al. Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and withoutrisks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017. Eur Radiol,2020,30(1):461-470.
[9] Liang B, Zhong L, He Q, et al.Diagnostic accuracy of serum ca19-9 in patients with cholangiocarcinoma: a systematic review and meta-analysis.Med Sci Monit,2015,21:3555-3563.
[10] Mejia JC, Pasko J. Primary liver cancers: intrahepatic cholangiocarcinoma and hepatocellular carcinoma. Surg Clin North Am,2020,100(3):535-549.
[11] Zhang H, Yang T, Wu M, et al.Intrahepatic cholangiocarcinoma:epidemiology,risk factors,diagnosis and surgical management.Cancer Lett,2016,379(2):198-205.
[12] Liu GJ, Wang W, Lu MD, et al. Contrast-enhanced ultrasound for the characterization of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Liver Cancer,2015,4(4):241-252.
[13] 徐桂军,朱建友,翟慎国, 等.肝细胞癌与肝内周围型胆管细胞癌的螺旋CT动态增强与病理分析.中华肝胆外科杂志,2010,16(4):253-256.
[14] Xu HX, Chen LD, Liu LN, et al. Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination. Br J Radiol,2012,85(1016):1029-1037.
[15] Ogawa S, Kumada T, Toyoda H, et al.Evaluation of pathological features of hepatocellular carcinoma by contrast-enhanced ultrasonography: comparison with pathology on resected specimen. Eur J Radiol,2006,59(1):74-81.
[16] Sakamoto M, Hirohashi S, Shimosato Y. Early stages of multistep hepatocarcinogenesis: adenomatous hyperplasia and early hepatocellular carcinoma. Hum Pathol,1991,22(2):172-178.
[17] Choi BI, Takayasu K, Han MC. Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. Am J Roentgenol,1993,160(6):1177-1187.
[18] Galassi M, Iavarone M, Rossi S, et al. Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound. Liver Int,2013,33(5):771-779.
[19] Han J, Liu Y, Han F, et al.The degree of contrast washout on contrast-enhanced ultrasound in distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Ultrasound Med Biol,2015,41(12):3088-3095.
[20] 吴晓贝,罗鸿昌,李开艳等.超声造影LI-RADS分类在肝细胞癌诊断中的应用价值.中华超声影像学杂志,2018,27(11):936-941.
[21] Yang D, Li R, Zhang XH, et al.Perfusion characteristics of hepatocellular carcinoma at contrast-enhanced ultrasound: influence of the cellular differentiation, the tumor size and the underlying hepatic condition. Sci Rep, 2018,8(1):4713.
[22] 韦柳,李智贤,彭涛等.超声造影对不同病理类型及分化程度原发性肝癌的诊断价值.中华肝脏病杂志,2012,20(12):939-941.
[23] Li R, Yuan MX, Ma KS, et al. Detailed analysis of temporal features on contrast enhanced ultrasound may help differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma in cirrhosis. PLoS One,2014,9(5):e98612.