How is primary liver cancer diagnosed? Diagnostic examination methods for primary liver cancer

Liver cancer is often mistakenly considered an incurable disease. People think that once they are diagnosed with liver cancer, there is no hope of survival. This idea is extremely wrong. Although the early symptoms of liver cancer are not obvious, if it can be diagnosed and treated early in the early stages of liver cancer, the patient still has a chance of survival.

What are the tests for diagnosing liver cancer?

1. Ultrasound examination. B-ultrasound examination is economical and convenient. It can show the size, shape and location of the tumor, and the diagnostic accuracy rate is about 90%. The detection rate of liver lesions is also relatively high. This is one of the examination methods for early liver cancer. Generally speaking, it takes about 4 to 6 months for liver cancer to grow from 1 cm to 3 cm. So if liver cancer is not found in the first B-ultrasound liver cancer examination, take another examination after 4 to 6 months. The liver cancer should still be below 3 cm, and the treatment effect should be good.

2. Magnetic resonance imaging. Magnetic resonance imaging is a rapidly developing examination method in recent years. In the past, MRI was not as ideal as CT examination. Now, with the continuous development of MRI technology, the scanning time is getting faster and faster, and the resolution is getting higher and higher. It can also make a relatively accurate judgment for some small lesions in the liver. Now MRI also plays a very important role in the examination of liver cancer.

3. CT examination. CT examination of liver cancer is a very important method and is widely used in China. However, when the diameter of liver cancer is less than 2 cm or the density is close to that of normal liver parenchyma, it is difficult to show it on CT. Liver cancer is diffuse and difficult to detect on CT; it is difficult to distinguish between primary and secondary liver cancer.

4. Alpha-fetoprotein test. When ultrasound and/or CT scans are suspected of early liver cancer, an alpha-fetoprotein test is generally recommended for auxiliary diagnosis. Alpha-fetoprotein test is also one of the most common test methods to see if there are tumor markers. Alpha-fetoprotein has a certain sensitivity for the test, but we have also found clinically that some patients' alpha-fetoprotein levels may not be high. The alpha-fetoprotein level of liver cancer patients can be high, but patients with low alpha-fetoprotein levels cannot completely rule out the possibility of liver cancer.

5. pET-CT. pET-CT is a functional molecular imaging system that integrates pET and CT. It can not only accurately locate the anatomical location of the lesion through CT morphological imaging, but also reflect the biochemical metabolic information of the liver's space-occupying tissue through pET functional imaging. At the same time, whole-body scanning can understand the overall condition and evaluate the metastasis. It is one of the examination methods for early liver cancer. Patients with hepatitis B and other conditions can consider the examination, which can achieve the purpose of early detection of lesions and understand the size and metabolic changes of the tumor before and after treatment.

Diagnostic criteria for primary liver cancer

1. Pathological diagnostic criteria for primary liver cancer:

The gold standard is the diagnosis of HCC based on histopathological and/or cytological examination of biopsy or surgical resection of liver lesions or extrahepatic metastases.

2. Clinical diagnostic criteria for primary liver cancer:

Among all solid tumors, only HCC can be diagnosed using clinical diagnostic standards, which are recognized both domestically and internationally, are non-invasive, simple, convenient, and highly operable. It is generally believed that the diagnosis depends on three major factors, namely, the background of chronic liver disease, the results of imaging examinations, and the serum AFp level. However, the understanding and specific requirements of the academic community vary and often change, and there are errors in actual application. Therefore, based on my country's national conditions, previous domestic standards, and clinical practice, the expert group proposes that strict control and joint analysis should be adopted, requiring that the clinical diagnosis of HCC can be established when two of the following conditions (1) + (2) a or three of (1) + (2) b + (3) are met at the same time:

1. Evidence of liver cirrhosis and HBV and/or HCV infection (HBV and/or HCV antigen positive).

2. Serum AFp ≥ 400 μg/L for 1 month or ≥ 200 μg/L for 2 months, and other causes of AFp elevation can be excluded, including pregnancy, embryonic tumors of the reproductive system, active liver disease and secondary liver cancer.

3. Typical imaging features of HCC: Concurrent multi-slice CT scans and/or dynamic contrast-enhanced MRI examinations show rapid heterogeneous vascular enhancement (arterial hypervascularity) of liver masses in the arterial phase, and rapid washout in the venous phase or delayed phase.

(1) If the liver mass is 1-2 cm in diameter, both CT and MRI imaging examinations are required to show that the liver mass has the above-mentioned characteristics of liver cancer before HCC can be diagnosed in order to enhance the specificity of the diagnosis.

(2) If the diameter of the liver mass is ≥ 2 cm and one of the two imaging examinations, CT or MRI, shows that the liver mass has the above-mentioned characteristics of liver cancer, HCC can be diagnosed.