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Objective To evaluate the clinical value of Fluorine-18-fluorodeoxyglucose (18F-FDG) positron-emission temography-computed tomography (PET-CT) examination in intrahepatic cholangiocarcinoma (ICC) staging.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 190 patients with ICC who were admitted to the Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Military Medical University from September 2013 to June 2016 were collected.There were 107 males and 83 females,aged from 37 to 79 years,with an average age of 57 years.There were 90 cases without distant metastasis undergoing surgery treatment and 100 with distant metastasis undergoing non-surgical treatment.Patients underwent preoperative CT,magnetic resonance imaging (MRI),and PET-CT examination,and then received surgery or non-surgery according to preference of patients and their family members.Observation indicators:(1) imaging features on preoperative CT,MRI,PET-CT examination;(2) treatment;(3) evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation;(4) evaluation of regional lymph node metastasis by three tests in ICC staging of patients undergoing operation;(5) evaluation of distant metastasis in ICC staging by three tests.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by single factor ANOVA and paired comparison was analyzed by SNK method.Measurement data with skewed distribution were described as M (range).Count data were described as absolute number or percentage,and comparison between groups was analyzed using the chi square test.Results (1) Imaging features on preoperative CT,MRI,PET-CT examination:all the 190 patients received routine upper abdominal CT,MRI,and systemic PET-CT examination before treatment.CT imaging of ICC showed inhomogeneous low density on plain scan,peripheral enhancement in arterial phase,persistent enhancement of tumor margin in portal phase,and sometimes mild to moderate centripetal enhancement.MRI imaging showed heterogeneous low signal on T1-weighted imaging,uneven high,and slightly high signal on T2-weighted imaging.Reinforcement on MRI is the same as CT.Transverse images,fusion transverse images and maximum intensity projection images of PET-CT imaging showed abnormal high FDG uptake around the tumor.(2) Treatment:81 out of the 90 ICC patients with surgery treatment underwent hepatectomy and lymphadenectomy,and 9 underwent only tumor tissue biopsy and lymph node biopsy due to intraoperative finding of abdominal metastasis.Of the 100 non-operated patients,30 received systemic chemotherapy,23 received local radiotherapy,and 47 gave up treatment.(3) Evaluation of tumor diameter,multiple tumors,macrovascular invasion,and bile duct invasion by three examinations in ICC staging of patients undergoing operation:the tumor diameters of ICC on CT,MRI and PET-CT were (6.8±2.8)cm,(6.9±2.9)cm,(7.2±2.8)cm,respectively.There was no significant difference among the three methods (F=0.085,P＞0.05).CT,MRI,PET-CT had similar accuracy of 80.0％ (72/90),78.9％ (71/90),72.2％ (65/90) on diagnosing multiple tumors,87.8％(79/90),92.2％ (83/90),94.4％ (85/90) for macrovascular invasion,and 93.3％ (84/90),95.6％ (86/90),96.7％ (87/90) for vascular and bile duct invasion,respectively,there was no significant difference in the above indicators between the three groups (x2 =1.801,2.662,1.131,P＞0.05).(4) Evaluation of regional lymph node metastasis by three examinations in ICC staging of patients undergoing operation:the accuracy of CT,MRI and PET-CT examination for lymph node metastasis was 62.2％ (56/90),68.9％(62/90),86.7％ (78/90) and sensitivity was 40.0％ (16/40),47.5％ (19/40),80.0％ (32/40),respectively,showing significant differences between the three groups (x2 =14.446,14.666,P＜0.05),showing a significant difference between CT and PET-CT examination (x2=14.134,13.333,P＜0.05),showing a significant difference between MRI and PET-CT examination (x2=8.229,9.141,P＜0.05).The sensitivity of CT,MRI and PET-CT examination for lymph node metastasis was 80.0％ (40/50),86.0％ (43/50),92.0％ (46/50),showing no significant difference between the three groups (x2=2.990,P＞0.05).(5) Evaluation of distant metastasis in ICC staging by three tests:there were 27,34 and 100 cases with distant metastasis evaluated by CT,MRI and PET-CT examination,including 40 with supraclavicular lymph node metastasis,32 with bone metastasis,30 with mediastinal lymph node metastasis,20 with hilar lymph node metastasis,17 with pulmonary metastasis;77 patients had more than 2 sites of metastasis.The accuracy of CT,MRI and PET-CT examination for distal metastasis in 190 ICC patients was 61.58％ (117/190),65.26％ (124/190),98.42％ (187/190),respectively,with a significant difference between the three groups (x2=83.639,P＜0.05),with a significant difference between CT and PET-CT examination (x2=80.592,P＜0.05),between MRI and PET-CT examination (x2=70.284,P＜ 0.05).Conclusion PET-CT examination makes up for the deficiency of CT and MRI in judging regional lymph node metastasis and distant metastasis,and contributes to the clinical staging of ICC.
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Objective To evaluate the surgical efficacy of benign tumor of liver in the caudate lobe.Methods The clinical data of 112 patients with benign tumor of liver in the caudate lobe who were admitted to the Eastern Hepatobiliary Surgery Hospital from January 2003 to April 2014 were retrospectively analyzed.The leftsided approach,right-sided approach,bilateral approach,central anterior approach and retrograde caudate lobectomy were selected according to the location and size of the tumor.All the patients were followed up by outpatient examination and telephone interview up to October 2014.Results Of all the 112 patients who received complete resection of tumor,33 patients received caudate lobectomy (22 by bilateral approach,11 by left-sided approach),28 received left hemihepatectomy + caudate lobectomy (by left-sided approach),21 received mesohepatectomy + caudate lobectomy (by central anterior approach),19 received partial right hepatectomy + caudate lobectomy (by right-sided approach),11 received right hemihepatectomy + candate lobectomy (9 by right-sided approach,2 by retrograde caudate lobectomy).During the operation,72 patients received vascular inflow occlusion,29 received vascular inflow occlusion combined with hepatic veins occlusion,6 received total hepatic vascular exclusion and 5 did not receive vascular inflow occlusion.The operation time,mean time of vascular inflow occlusion,mean volume of intraoperative blood loss,cases of blood transfusion,mean volume of blood transfusion and duration of postoperative hospital stay were (192 ± 69)minutes,28 minutes (range,0-94 minutes),590 mL (range,100-12 000 mL),68,600 mL (range,200-10 000mL) and (8.2 ± 2.7) days,respectively.Thirty-one patients had postoperative complications,including 21 with bile leakage,7 with medium and above volume of pleural effusion,2 with postoperative bleeding and 1 with hepatic failure.The complications were cured after symptomatic treatment.No patient died perioperatively.All the 112 patients were followed up for a median time of 12 months (range,6-24 months).All patients were survived well and without tumor recurrence during the follow-up.Conclusions Surgical treatment is an effective method for benign tumor of liver in the caudate lobe,with the good recovery of patients and definitive surgical efficacy.The key factors of surgical treatment include strictly following operative indication,rationally optimizing surgical approach,suitably selecting vascular inflow occlusion and the accurate operation.
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Objective To investigate the significance of XAGE-1bmRNA expression in the blood specimens of patients with primary liver cancer, cirrhosis and benign liver diseases and in healthy individuals. Methods Venous blood specimens of patients with primary liver cancer (n= 125), cirrhosis (n= 23), benign liver diseases (n= 34) and healthy individuals (n = 41 ) were collected. XAGE-1b mRNA was detected by real-time fluorescence quantitative PCR. Results The expression levels of XAGE-1b mRNA in patients with primary liver cancer, cirrhosis, benign liver diseases and healthy in dividuals were 3.72 (0.93, 10.2) ×10-5, 0 (0, 0. 56) ×10-5, 0 (0, 0)×10-5, 0 (0, 0) ×10-5, respectively. The XAGE-1b mRNA expression in patients with primary liver cancer was obviously higher than the patients with cirrhosis, benign liver diseases and in healthy individuals. The expression levels for patients with cirrhosis was higher than patients with benign liver diseases and in healthy individuals. The expression levels for patients with benign liver diseases and healthy individuals were similar. With a optimal cut-off value of 8. 385 × 10-7 , the sensitivity, specificity, positive predictive value, and negative predictive value of XAGE-lb mRNA for diagnosing primary liver cancer were 80. 0%, 89.8%, 90.9% and 77.9% respectively. The positive rates for patients with primary liver cancer and cirrhosis were 80.0% and 30.4% respectively. Conclusion XAGE-lb mRNA can be used as a tumor marker for primary liver cancer. It contributes to the differentiation between primary liver cancer, cirrhosis and benign liver diseases.
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Objective To study the clinical,imaging and pathological features of hepatic angiomyolipoma,and to investigate methods in improving the preoperative diagnosis rate.Methods The imaging features and treatment experience of 73 patients with hepatic angiomyolipoma who had been admitted to the Eastern Hepatobiliary Surgery Hospital from 2000 to 2007 were retrospectively analyzed.All patients were classified according to the imaging features and corresponding treatments were applied.Results Of all patients,7 were diagnosed preoperatively.The diagnostic rate of B ultrasound,computed tomography and magnetic resonance imaging were 0,13%(7/56)and 6% (2/33),respectively.According to the results of imaging examination,6 patients were with the type of hemangioma,17 with the type of lipoma,4 with the type of leiomyoma and 46 with mixed type.One patient was treated by radiofrequeney ablation and 72 by surgical resection.Twenty-four patients were presented with pulmonary infection,pleural effusion,ascites or slight hepatic dysfunction.Postoperative immunohistochemical assay demonstrated that HMB45 had the highest positive expression rate,then followed by smooth muscle actin,vimentin,proliferating cell nuclear antigen,CD34,polyclonal carcinoembryonic antigen,CD18,CD19 and p53.One patient died of postoperative tumor recurrence.Conclusions Hepatic angiomyolipoma is easy to be misdiagnosed,while imaging classification is helpful in the diagnosis.Surgical resection is beneficial to patients with hepatic angiomyolipoma.
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Objective This study was to systemically evaluate the efficacy of TACE before hepatectomy on resectable primary HCC.Methods The articles focused on preoperative TACE for resectable primary HCC,published from Jan.1,1980 to Jan.1,2008,were selected by computerized search of literatures and manual search of bibliographies.The clinical controlled trials meeting inclusion criteria were reviewed systematically by meta-analysis.The reported data were processed with the statistical techniques of meta analysis.The combinability of the studies was assessed in terms of clinical and statistical criteria.Tumor-free survival rate was calculated.And pooled estimates were computed according to a fixed or random effect model by heterogeneity.Results A total of 1288 patients were included in 8 trials.There was no difference between the two groups in the 1,3-year tumor-free survival rate.Conclusion Preoperative TACE for resectable primary hepatic carcinoma can't improve survival rate.