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DOI: 10.1055/s-2003-39637
Increasing Sensitivity of Morphological Diagnosis in Hepatocellular Carcinoma (HCC) by Combination of Cytological and Fine-Needle Histological Examination after Ultrasound Guided Fine Needle Biopsy
Gesteigerte Sensitivität der morphologischen Diagnostik durch die Kombination von zytologischer und Feinnadel-histologischer Untersuchung beim hepatozellulären Karzinom (HCC) nach ultraschallgesteuerter BiopsiePublication History
Manuscript received: 27. February 2003
Accepted after revision: 13. March 2003
Publication Date:
12 June 2003 (online)

Zusammenfassung
Gesteigerte Sensitivität der morphologischen Diagnostik durch die Kombination von zytologischer und Feinnadel-histologischer Untersuchung beim hepatozellulären Karzinom (HCC) nach ultraschallgesteuerter Biopsie.
Studienziel: Wir untersuchten Faktoren, welche die Sensitivität der morphologischen Diagnostik (Zytologie und Feinnadelhistologie) beim HCC nach ultraschallgezielter Biopsie beeinflussen.
Methode: Bei 62 Patienten wurde eine ultraschallgezielte Punktion durchgeführt. Das gewonnene Material wurde zytologisch (n = 62), Feinnadel histologisch (n = 45) und zytophotometrisch (n = 62) untersucht.
Ergebnisse: Die Sensitivität der zytologischen und histologischen Diagnostik betrug jeweils ca. 80 %. Durch die Kombination beider Methoden konnte die Sensitivität auf 89 % gesteigert werden. Bei sieben Patienten konnte das HCC primär nicht morphologisch gesichert werden, bei neun Patienten fand sich zwischen histologischer und zytologischer Untersuchung kein kongruentes Ergebnis. Diese 16 Patienten (Gruppe A) wurden im Hinblick auf Größe des punktierten Herdes, Tumorstadium, zytophotometrischen Befund und Überleben mit den 46 Patienten (Gruppe B) verglichen, bei denen das HCC morphologisch primär diagnostiziert wurde. Statistisch zeigte sich ein signifikant geringerer Anteil an Tumoren mit diploiden oder tetraploiden (euploiden) Zellen in Gruppe B. Euploide Tumoren waren signifikant höher differenziert.
Bei den Patienten mit euploiden Tumoren betrug die Sensitivität der Zytologie 67 % und die der Feinnadelhistologie 75 %. Durch die Kombination beider Verfahren konnte die Sensitivität auf 82 % gesteigert werden. Durch Kombination der zytologischen und histologischen Untersuchung konnte eine Steigerung der Sensitivität von 93 bzw. 88 % auf 97 % bei den aneuploiden Tumoren erreicht werden.
Zusammenfassung: Die Sensitivität der morphologischen Diagnostik kann insbesondere bei hochdifferenzierten HCC mit physiologischem DNA-Gehalt durch die Kombination von zytologischer und feinnadelhistologischer Untersuchung erhöht werden.
Abstract
Increasing sensitivity of morphological diagnosis by combination of cytological and fine-needle histological examination after ultrasound guided fine needle biopsy in hepatocellular carcinoma (HCC).
Aim: We investigated the factors which may affect the sensitivity of morphological diagnostics (cytology and fine-needle histology) in HCC after ultrasound guided biopsy.
Method: In 62 patients, an ultrasound guided cytological (n = 62) and fine-needle histological (n = 45) biopsy was performed. In addition, the smears were investigated by cytophotometry (n = 62).
Results: Considering each method separately, the sensitivity of both cytological and histological diagnostics was about 80 %. The sensitivity could be raised to 89 % by combining the two methods. In seven patients, the HCC could not be primarily confirmed morphologically. In nine patients, the result of histological and cytological investigation was not congruent. With regard to the size of the biopsied lesion, tumor stage, cytophotometric finding and survival these 16 patients (group A) were compared with the 46 patients in whom the HCC could be primarily confirmed morphologically (group B). The statistical analysis did reveal a significantly lower percentage of tumors with diploid or tetraploid (euploid) cells in group B. Euploid tumors were significantly more highly differentiated.
In patients with euploid tumors, the sensitivity of the cytological investigation was 67 % and respectively 75 % of the histological investigation. The sensitivity could be raised to 82 % in this population by combining the two investigations. On the other hand in aneuploid tumors, the sensitivity could only be increased from 93 % and 88 % respectively to 97 % by combining cytology and fine-needle histology.
Summary: Our investigations show that the sensitivity of morphological diagnostics can be raised especially in the highly differentiated HCC with a physiological DNA content by combination of cytological and fine-needle histological investigations.
Schlüsselwörter
Ultraschallgezielte Punktion - hepatozelluläres Karzinom - Zytophometrie
Key words
Ultrasound guided fine needle biopsy - hepatocellular carcinoma - cytophotometry
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Dr. Martin Caselitz
II. Medizinische Klinik, Klinikum Deggendorf · Perlasberger Str. 41 ·
94469 Deggendorf
Email: martin.caselitz@Klinikum-deggendorf.de