PO.PS01.04 · 人群科学
错失的机会还是标准诊疗
Missed opportunity or standard of care
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
纤维板层型癌（FLC）是一种罕见癌症，主要影响儿童和青壮年，在影像学上易与常见的局灶性结节性增生（FNH）相混淆。通常在初次就诊时不进行活检，从而可能错失FLC早期诊断的机会。我们的研究旨在评估延迟诊断的影响，并基于这些结果对当前HCC肝活检指南提出补充建议。我们回顾了过去10年间在我们数据库中拥有完整记录的所有FLC患者。这是一项回顾性观察研究，初始纳入216例患者。我们排除了未提及良性肿瘤或FNH、或没有FLC病理诊断的患者。排除后，我们获得了一个35例患者的队列。我们将该队列与95例拥有完整记录且在诊断时未被假定为FNH的患者进行了比较。采用Mann-Whitney U检验比较女性与男性之间首次影像与病理诊断之间的时间延迟。分析显示延迟与性别之间存在显著结果，U=59.00，Z=-2.189，p=0.028。女性的平均诊断延迟为347.85天（SD=571.686），男性的平均诊断延迟为41.22天（SD=31.630）。Mann-Whitney U检验显示，被假定为FNH者的延迟与未被假定者的延迟之间存在显著结果，U=647.500，Z=-5.591，p<0.001。基于这些结果，我们建议对当前推荐进行如下补充：1. 将FLC单独列出，与HCC分开成节。2. 应使用活检来确诊FLC或FNH。3. 建议在识别出特殊患者群体时应考虑活检。4. 对所有患者进行密切而可靠的随访。5. 若肿瘤位于手术复杂区域，且肿瘤生长可能显著影响预后或切除可能性，应考虑活检。6. 检测B12水平，若>2000 pg/mL，应建议活检。7. 应进行胸部X线检查以评估可能的肺结节。由于指南存在空缺，我们70%的患者经历了诊断延迟。我们认为，在当前肝活检指南中为FLC增加一个独立的、包含七项规定的章节，有助于弥补这一诊疗空缺。
查看英文原文 English abstract
Fibrolamellar Carcinoma (FLC) is a rare cancer that primarily affects children and young adults and is easily confused with the common Focal Nodular Hyperplasia (FNH) on imaging. Often, a biopsy is not performed at initial presentation and the opportunity for an early diagnosis of FLC can be missed. Our study aims to evaluate the effects of delayed diagnosis, and based on those results propose an addendum to the current HCC liver biopsy guidelines. We reviewed all FLC patients diagnosed in the last 10 years that had complete records in our database. This was a retrospective observation study that initially looked at 216 patients. We excluded patients who did not have a reference to benign tumors or FNH, or who did not have a pathological diagnosis of FLC. After exclusion we had a cohort of 35 patients. We compared this cohort to 95 patients who had complete records and were not assumed to have FNH at time of diagnosis. A Mann-Whitney U test was performed to compare the time delay between first images and pathological diagnosis between females and males. The analysis shows a significant result between delay and sex, U=59.00, Z= -2.189 p= 0.028. The average diagnostic delay in females was 347.85 days SD= 571.686 and the average diagnostic delay was 41.22 days SD= 31.630 in males. A Mann-Whitney U test showed a significant result between delay in those assumed to have FNH and delay in those who did not, U = 647.500, Z= -5.591, p= <0.001. Based on these results we are suggesting an addendum to the current recommendations. 1. Give FLC its own section separate from HCC 2. Biopsy should be used to confirm diagnosis of FLC or FNH 3. Recommend that a biopsy should be considered when a unique patient population is identified. 4. Close and reliable follow-up for all patients 5. If the neoplasm is in a surgically complicated area, where tumor growth could significantly affect prognosis or possibility of resection, a biopsy should be considered 6. Acquire B12 levels, if they are >2000pg/mL a biopsy should be recommended. 7.A chest x-ray should be acquired to assess possible lung nodules. Due to the gap in guidelines, 70% of our patients experienced a delay in diagnosis. We believe that adding a separate section in the current liver biopsy guidelines for FLC with seven stipulations could help amend this gap in care.
利益披露 Disclosure
L. Olsen, None..
A. Logan, None.