Clinical Study Of Percutaneous Transhepatic Biopsy Of Hepatic Focal Lesions Guided By Contrast-enhanced Ultrasonography

Objectiv To investigate the application of percutaneous transhepatic biopsy guided by contrast-enhanced ultrasonography and evaluate its clinical value.Mthonds Two hundred patients with focal hepatic lesion were randomly grouped into experiment-group and control-group. There were one hundred patients in experiment-group,including fifty-one cases primary hepatocellular carcinoma(forty-one cases were after nonoperative therapy,nine cases were accompanied with cirrhotic liver),thirteen cases primary cholangiocellular carcinoma(three cases were accompanied with cirrhotic liver),one case hepatic malignant lymphoma, one case hepatic metastatic tumor,fifteen cases hepatic focal nodular hyperplasia,nine cases hepatic abscess,eight cases hepatic tuberculosis,two cases hepatic fungal infection.There were one hundred patients in control-group,including fifty two cases primary hepatocellular carcinoma(thirty nine cases were after nonoperation therapy,ten cases were accompanied with cirrhotic liver),sixteen cases primary cholangiocellular carcinoma(one case accompanied with cirrhotic liver), seven cases hepatic hemangioma,fourteen cases hepatic focal nodular hyperplasia,nine cases hepatic abscess,one case hepatic syphilis,one case hepatic tuberculosis.Experiment-group was examined by contrast-enhanced ultrasonography,and then choice the target of puncture according to the result of the examination.Control-group was examined by traditional ultrasonography,then choice the target of puncture according to the result of examination.To compare the biosy achievement ratio puncturing only one time,accurate diagnosis ratio, sensitivity and specificity of experiment-group with control-group,and to compare the biosy achievement ratio puncturing only one time,accurate diagnosis ratio of different character nodules between two groups. To compare the average times of puncture meanwhile.Results The average times of puncture of experiment-group was 1.00±0, was lower than that of control-group (1.1±0.41,P<0.05). The biopsy achievement ratio puncturing one time,accurte diagnosis ratio,sensitivity of experiment-group was 100%,98%,98.99 % , was higher than that of control-group respectively (94%,91%,90.91%,P<0.05).There was no significant difference between the specificity of two groups. The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of the benign lesions diameter more than 5cm in experiment-group and control-group was 100%,100%,92.3%,92.3% respectively ,there was no signicant difference between them(P>0.05).The accurate diagnosis ratio of malignant lesions diameter more than 5cm in two groups was 100%,82.14% respectively, there was significant difference between them (P<0.05).The accurate diagnosis ratio of all the lesions diameter more than 5cm in exprement-group and control-group was 100%,85.36% respectively ,there was significant differcence between them(P<0.05).The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of the benign lesions diameter from 2.1cm to 4.9cm in exprement-group and control-group was 100%,100%,94.44%,100% respectively,there was no significant difference between them(P>0.05).The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of the malignant lesions diameter from 2.1cm to 4.9cm in exprement-group and control-group was 100%,91.30% ,97.05%,97.05% respectively,there was no significant difference between them(P>0.05). The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of all the lesions diameter from 2.1cm to 4.9cm in exprement-group and control-group was 100%,95.56%,96.15%,98.07% respectively,there was no significant difference between them(P>0.05). The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of the malignant lesions diameter smaller than 2cm in exprement-group and control-group was 100%,50% respectively,there was significant difference between them(P<0.05). The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of primary hepatocellular carcinoma after nonoperation therapy in experiment-group and control-group was 100%,100%,97.43%,84.61% respectively,there was no significant difference between the biosy achievement ratio puncturing only one time of two groups(P>0.05),there was significant difference between the accurate diagnosis ratio of two groups(P<0.05). The biosy achievement ratio puncturing only one time,accurate diagnosis ratio of primary hepatocellular carcinoma accompanied with cirrhotic liver in two groups was 100%,100%,72.72%,72.72% respectively , there was significant difference between the biosy achievement ratio puncturing only one time of two groups (P<0.05),and the accurate diagnosis ratio of two groups. (P<0.05).There was no cases bleeding,infection caused by puncture in experiment-group and control-group.Conclusions Contrast-enhanced ultrasonography can increase the biopsy achievement ratio,accurate diagnosis ratio, sensitivity of percutaneous transhepatic biopsy,can decrease the average times of puncture ,meanwhile.But the effect of guide by contrast-enhanced ultrasonography was different for different lesions.It can improve the biopsy achievement ratio more for bigger,smaller or malignant lesions, can hardly improve the biopsy achievement ratio for moderate diameter or benign lesions. Especially for the carcinomatous nodules after nonoperative therapy or accompanied with cirrhotic liver,contrast-enhanced ultrasound can decrease the false negative results of biopsy evidently .