Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2009; 15(18): 2245-2251
Published online May 14, 2009. doi: 10.3748/wjg.15.2245
Contrast-enhanced sonography versus biopsy for the differential diagnosis of thrombosis in hepatocellular carcinoma patients
Paolo Sorrentino, Salvatore D’Angelo, Luciano Tarantino, Umberto Ferbo, Alessandra Bracigliano, Raffaela Vecchione
Paolo Sorrentino, Salvatore D’Angelo, Liver Unit, Clinical and Experimental Hepatology, Department of Internal Medicine, S.G. Moscati Hospital, 83100 Avellino, Italy
Paolo Sorrentino, Alessandra Bracigliano, Raffaela Vecchione, Department of Biomorphological Science, University of Naples Federico II, 80131 Naples, Italy
Luciano Tarantino, Hepatology and Interventional Ultrasound Unit, S. Giovanni di Dio Hospital, ASL 3, 80027 Frattamaggiore, Naples, Italy
Umberto Ferbo, Institute of Pathology, S.G. Moscati Hospital, 83100 Avellino, Italy
Author contributions: Sorrentino P, and Tarantino L performed the majority of examinations; Ferbo U and Vecchione R were the pathologists; Sorrentino P, D’Angelo S and Bracigliano A designed the study and wrote the manuscript.
Correspondence to: Paolo Sorrentino, Liver Unit, Clinical and Experimental Hepatology, Department of Internal Medicine, S.G. Moscati Hospital, Via Pennini, 83100 Avellino, Italy.
Telephone: +39-82-5203810
Fax: +39-82-5203859
Received: October 25, 2008
Revised: March 9, 2009
Accepted: March 16, 2009
Published online: May 14, 2009

AIM: To clarify which method has accuracy: 2nd generation contrast-enhanced ultrasound or biopsy of portal vein thrombus in the differential diagnosis of portal vein thrombosis.

METHODS: One hundred and eighty-six patients with hepatocellular carcinoma and portal vein thrombosis underwent in blinded fashion a 2nd generation contrast-enhanced ultrasound and biopsy of portal vein thrombus; both results were examined on the basis of the follow-up of patients compared to reference-standard.

RESULTS: One hundred and eight patients completed the study. Benign thrombosis on 2nd generation contrast-enhanced ultrasound was characterised by progressive hypoenhancing of the thrombus; in malignant portal vein thrombosis there was a precocious homogeneous enhancement of the thrombus. On follow-up there were 50 of 108 patients with benign thrombosis: all were correctly diagnosed by both methods. There were 58 of 108 patients with malignant thrombosis: amongst these, 52 were correctly diagnosed by both methods, the remainder did not present malignant cells on portal vein thrombus biopsy and showed on 2nd generation contrast-enhanced ultrasound an inhomogeneous enhancement pattern. A new biopsy during the follow-up, guided to the area of thrombus that showed up on 2nd generation contrast-enhanced ultrasound, demonstrated an enhancing pattern indicating malignant cells.

CONCLUSION: In patients with hepatocellular carcinoma complicated by portal vein thrombosis, 2nd generation contrast-enhanced ultrasound of portal vein thrombus is very useful in assessing the benign or malignant nature of the thrombus. Puncture biopsy of thrombus is usually accurate but presents some sampling errors, so, when pathological results are required, 2nd generation contrast-enhanced ultrasound could guide the sampling needle to the correct area of the thrombus.

Keywords: Hepatocellular carcinoma, 2nd generation contrast enhanced ultrasound, Contrast enhanced sonography, Malignant thrombosis, Portal vein biopsy