Analysis of clinical and contrast-enhanced ultrasound characteristics of combined hepatocellular carcinoma and cholangiocarcinoma / 中华医学超声杂志（电子版）

ABSTRACT

Objective To analyze the clinical characteristics and enhancement pattern on contrast-enhanced ultrasound (CEUS) of combined hepatocellular-cholangiocarcinoma (cHCC-CC).Methods A total of 49 patients who were pathologically confirmed as cHCC-CC by surgery and underwent CEUS examination in Southwest Hospital Affiliated to Third Military Medical University from January 2005 to February 2015 were retrospectively enrolled.There were 3 enhancement patterns on CEUShepatocellular carcinoma (HCC) pattern,cholangiocarcinoma (CC) pattern and indeterminate pattern.The proportions of HCC pattern and CC pattern of cHCC-CC were compared by x2 test.And the proportions of tumour maker elevation [(alpha-fetoproteins,AFP) and/or (carbohydrate antigen,CA19-9)] in accordance or discordance with enhancement patterns were compared by x2 test.Results Among the 49 cHCC-CC patients,44 were male and 5 were female.Mean age was (52.3 ± 9.8) years old (range28-74 years old).Of all cases,41 (83.7％,41/49) patients had single nodule.Mean size of nodule was (5.3 ± 3.5) cm (range1.5-13.8 cm),and the size of 51.0％ (25/49) lesions were ＜ 5 cm.Totally 34 (69.4％,34/49) patients had pathologically diagnosed cirrhosis.AFP elevation was found in 31 (63.3％,31/49) patients,CA19-9 elevation was found in 12 (24.5％,12/49) patients,simultaneous elevation of both AFP and CA19-9 was found in 9 (18.4％,9/49) patients.The percentages of CC pattern and HCC pattern were 51.0％ (25/49) and 44.9％ (22/49) respectively.And there was no significant difference between the two patterns (x2=0.368,P=0.544).In 9 patients with simultaneous elevation of both AFP and CA19-9,CC pattern was observed in 5 patients and HCC pattern was noted in 4 patients.There were 12 (24.5％,12/49) patients with tumor marker elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS.Among the 12 cases,9 cases with AFP elevation were CC patterns on CEUS and 3 cases with CA19-9 elevation were HCC patterns on CEUS.Simultaneous elevation of tumor makers (AFP and CA19-9) or tumor mark elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS was found in 21 (42.9％,21/49) patients,which was significantly more than simultaneous elevation of AFP and CA19-9 alone (18.4％,9/49) (x2=6.918,P=0.009).Conclusions Clinical characteristics of patients with cHCC-CC were similar to that of patients with HCC.The proportion of HCC pattern and CC pattern was comparable.Combination of test of tumor makers (AFP and CA19-9) and enhancement pattern on CEUS maybe helpful for the diagnosis of cHCC-CC.