What are the auxiliary diagnoses for pediatric liver tumors?

The continuous development of serology and imaging has provided various methods for the diagnosis of pediatric liver tumors. Clinically, serological diagnosis is called "qualitative diagnosis", imaging diagnosis is called "localization diagnosis", and puncture biopsy or exfoliated cell examination is called "pathological diagnosis". The comprehensive application of these methods can improve the accuracy of pediatric liver tumor diagnosis.

1. Alpha-fetoprotein (AFP) detection The accuracy of AFP for liver cells is about 90%, and its clinical value is:

(1) Early diagnosis: It is possible to diagnose subclinical lesions and make a diagnosis about 8 months before the onset of symptoms.

(2) Differential diagnosis: Since 89% of hepatocellular carcinoma patients have serum AFP greater than 20 ng/ml, liver cancer can be ruled out if the AFP is lower than this value and there is no other evidence of liver cancer.

(3) It helps reflect the improvement or deterioration of the condition. An increase in AFP indicates deterioration, while a decrease indicates improvement if clinical conditions also improve.

(4) It helps to determine the completeness of surgical resection and predict recurrence. A decrease in AFP to normal values ​​after surgery indicates complete resection, while a decrease and then increase indicates recurrence. It can also predict recurrence 6 to 12 months before the onset of recurrence symptoms.

(5) It helps to evaluate various treatment methods. The higher the AFP negative conversion rate after treatment, the better the effect.

AFP false positive, not all AFP positive patients have liver cancer, AFP false positive is mainly seen in hepatitis, liver cirrhosis, the two account for 80% of false positive cases, in addition to gonadal embryonal carcinoma, digestive tract cancer, pathological pregnancy, hepatic hemangioendothelioma, malignant liver fibroma, etc. In the diagnosis of AFP negative patients, when AFP negative cannot exclude the diagnosis of liver cancer, enzyme tests can be performed, among which the more clinically significant ones are: α1 antitrypsin (AAT), γ-glutamyl transpeptidase (γ-GT), carcinoembryonic antigen (CEA), alkaline phosphatase (AKP), etc. These serological test results may increase in patients with liver disease, but they are not specific.

2. Liver puncture biopsy: If the diagnosis is basically clear, liver puncture can be omitted, because liver puncture has certain complications, the most common of which is bleeding. In addition, during liver puncture, the puncture needle will pass through the portal vein or hepatic vein and bile duct. In this case, cancer cells may be brought into the blood vessels and cause metastasis.

(1) Ultrasound can show tumors larger than 1 cm with a diagnostic accuracy rate of 90%. It can show the size, location, morphology, number, hepatobiliary duct, portal vein, spleen, abdominal lymph nodes, etc. of the tumor. It can also diagnose the presence of cirrhosis, splenomegaly, and ascites.

(2) The diagnostic accuracy of CT for pediatric liver tumors is 93%, and the minimum resolution is 1.5 cm. Its advantage is that it can directly observe the size and location of the tumor and its relationship with the hepatic vein and portal vein, and can diagnose whether there is a cancer thrombus in the portal vein or hepatic vein.

(3) Angiography Hepatic artery angiography can help understand the blood supply of the lesion and determine the possibility and indications of surgery. It can show tumors of about 1.5 cm and is the most resolvable imaging diagnostic method currently available. It is also important for identifying hepatic hemangiomas. While confirming the diagnosis, it can also help understand whether the hepatic artery has any mutations, which is very helpful for liver resection.

(4) MRI and CT are basically the same, but MRI is helpful for some liver masses that are difficult to identify. T1 and T2 images can more clearly distinguish liver cancer, hepatic hemangioma, liver abscess, cyst, etc.

(5) Radionuclide scanning can be used to identify patients with hemangiomas that are difficult to differentiate from them using blood flow scanning. However, due to the low resolution of radionuclide scanning, it is rarely used as a method for diagnosing pediatric liver tumors.

(6) Laparoscopy can be considered for patients who are difficult to diagnose to directly observe the liver, tumors on the liver surface, and the conditions within the abdominal cavity.

(7) X-ray examination: X-ray fluoroscopy may reveal an elevated right diaphragm, limited movement, or localized protrusion. In 30% of cases, calcifications may be seen in the tumor on plain X-ray films. In approximately 10% of cases, lung metastases may be detected at diagnosis.

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