<b>Pretransplantation Diagnosis and Staging of Hepatocellular Carcinoma in Patients with Cirrhosis:</b> Value of Dual-Phase Helical CT

Valls, Carlos; Cos, Mònica; Figueras, Juan; Andía, Eduard; Ramos, Emilio; Sánchez, Anna; Serrano, Teresa; Torras, Jaume

doi:10.2214/ajr.182.4.1821011

Cited by 88 publications

(63 citation statements)

References 23 publications

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“…Multiphasic CT is being widely applied for preoperative evaluation of patients with HCC [15]. This study was designed to assess the usefulness of pre-operative CT findings with axial, coronary and sagittal planes in the prediction of microvascular invasion in HCC.…”

Section: Discussionmentioning

confidence: 99%

Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Rc²,

Cw³

et al. 2012

BJR

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Objective: The aim of this study was to diagnose microvascular invasion in patients with solitary hepatocellular carcinoma (HCC) from pre-operative CT imaging. Methods: 102 patients with solitary HCC who underwent curative hepatectomy were retrospectively included in our study. The pre-operative 3-phase CT imaging and laboratory data for the 102 patients were reviewed. Tumour size, tumour margin, peritumoral enhancement and a-fetoprotein level were assessed. Surgical pathology was reviewed; tumour differentiation, liver fibrosis score and microvascular invasion were recorded. Results: The histopathological results revealed that 50 HCCs were positive and the other 52 were negative for microvascular invasion. Univariate analysis revealed that tumour size (p50.036), higher Edmondson-Steiner grade (p50.047) and non-smooth tumour margin (p,0.001) showed statistically significant associations with microvascular invasion. Multivariate logistic regression analysis showed that non-smooth tumour margin had a statistically significant association with microvascular invasion only (p,0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the non-smooth tumour margin in the prediction of microvascular invasion were 66%, 86.5%, 82.5% and 72.6%, respectively. Conclusion: Non-smooth tumour margin in pre-operative CT had a statistically significant association with microvascular invasion. More aggressive treatment should be considered in HCC patients with suspected positive microvascular invasion. Hepatic resection is a potentially curative treatment modality for patients with hepatocellular carcinoma (HCC) [1][2][3][4]. Histopathological vascular tumour invasion is a well-known major prognostic factor for patients with HCC who have undergone hepatic resection or liver transplantation [5][6][7][8]. Iwatsuki et al [9] reported that microvascular and macrovascular invasions were associated with a 4.4-and 15-fold increased risk of recurrence, respectively, for patients who had undergone liver transplantation. Because microvascular tumour invasion has a significant impact on recurrence and prognosis, preoperative diagnosis of microvascular invasion is needed.Radiological detection of microvascular tumour invasion may facilitate the pre-operative prediction of a patient's prognosis. Many researchers have tried to elucidate microvascular invasion based on pre-operative imaging studies, including CT during hepatic angiography, dynamic MRI and superparamagnetic iron oxideenhanced MRI [10][11][12][13]. However, radiological findings suggestive of microvascular invasion in pre-operative CT have not yet been well established. The purpose of our study was to diagnose microvascular invasion in patients with solitary HCC from pre-operative triphasic CT findings. Methods and materials PatientsApproval for retrospective study was obtained from our institutional review board. Between January 2007 and December 2009, 153 patients with HCC who underwent elective curative hepatectomy in our institution were...

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Section: Discussionmentioning

confidence: 99%

Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Rc²,

Cw³

et al. 2012

BJR

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“…Further, since the establishment of these recommendations, significant improvements have been forthcoming with the advent of contrastenhanced harmonic ultrasonography (perfusional ultrasonography [US]), [14][15][16] and more experience has been achieved with multislice helical computed tomography (helical CT). 17,18 Magnetic resonance imaging also has evolved significantly, particularly with the use of reticuloendothelial and hepatospecific contrast agents. Therefore, it is important to establish the efficiency of the currently available advanced techniques (based on the EASL criteria) for the diagnosis of small HCC and whether the diagnostic approach to small nodules in livers with cirrhosis should be updated.…”

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confidence: 99%

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

et al. 2005

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In a prospective study, we examined the impact of arterial hypervascularity, as established by the European Association for the Study of the Liver (EASL) recommendations, as a criterion for characterizing small (1-3 cm) nodules in cirrhosis. A total of 72 nodules (1-2 cm, n ‫؍‬ 41; 2.1-3 cm, n ‫؍‬ 31) detected by ultrasonography in 59 patients with cirrhosis were included in the study. When coincidental arterial hypervascularity was detected at contrast perfusional ultrasonography and helical computed tomography, the lesion was considered to be hepatocellular carcinoma (HCC) according to EASL criteria. When one or both techniques showed negative results, ultrasound-guided biopsy was performed. In cases with negative results for malignancy or highgrade dysplasia, biopsy was repeated when an increase in size was detected at the 3-month follow-up examination. Coincidental hypervascularity was found in 44 of 72 nodules (61%; 44% of 1-2-cm nodules and 84% of 2-3-cm nodules). Fourteen nodules (19.4%) had negative results with both techniques (hypovascular nodules). Biopsy showed HCC in 5 hypovascular nodules and in 11 of 14 nodules with hypervascularity using only one technique. All nodules larger than 2 cm finally resulted to be HCC. Not satisfying the EASL imaging criteria for diagnosis were 38% of HCCs 1 to 2 cm (17% hypovascular) and 16% of those 2 to 3 cm (none hypovascular). In conclusion, the noninvasive EASL criteria for diagnosis of HCC are satisfied in only 61% of small nodules in cirrhosis; thus, biopsy frequently is required in this setting. Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule larger than 2 cm should be regarded as highly suspicious for HCC. (HEPATOLOGY 2005;42: 27-34.)

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“…So far, size of tumor by CT scan or MRI has been used for preoperative staging because size has been reported to correlate with vascular invasion, progression of tumor, and recurrence rate after transplantation (6)(7)(8)(9)(10)(11)(12). TNM staging is limited by the need to obtain pathologic information, and imagebased tumor assessment can be misleading given the difficulty in visualizing HCCs in the cirrhotic liver (6)(7)(8)(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…To confirm the suspicion of HCC by US in a patient with cirrhosis of the liver, the use of computed tomography (CT) is suggested (9). Its diagnostic efficacy depends on technical factors (injection of contrast) and on factors inherent to the tumor (tumor size and vascularity) (10,11). Magnetic resonance imaging (MRI) has been used to obtain a better characterization of hepatic lesions suggestive of HCC and also for their differentiation from benign lesions (12).…”

Section: Introductionmentioning

confidence: 99%

Differentially Expressed Genes between Early and Advanced Hepatocellular Carcinoma (HCC) as a Potential Tool for Selecting Liver Transplant Recipients

Mas

Maluf

Archer

et al. 2006

Mol Med

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Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. Liver transplantation (LT) represents a curative treatment for "small" HCC. Preoperative staging is critical in selecting optimal candidates for LT to optimize the use of this scarce resource. From December 1997 to February 2004, 148 patients diagnosed with cirrhosis and HCC were evaluated at our center. After staging, the patients were listed for LT according to United Network for Organ Sharing (UNOS) criteria. When pretransplant liver MRIs were compared with the findings of the explanted livers, 8 of 35 patients (22.8%) were understaged. Three of the 8 patients (37.5%) had recurrence post-LT. A retrospective gene expression profiling study was done using microarray technology for tumor samples in the pretransplant hepatitis C virus (HCV)-HCC understaged patients and in a contemporaneous group of HCV-HCC patients that were accurately staged. Two sample t tests comparing the early versus advanced HCV-HCCs with respect to gene expression showed an important set of genes differentially expressed among the samples. Hierarchical clustering analysis of the gene expression profiling classified 93.8% of the total tumor samples and 85.7% of the understaged samples in concordance with the explanted pathological staging. We found a distinctive pattern of gene expression between early and advanced HCV-HCCs. These results suggest that gene expression profiling could improve the pre-LT HCC staging to more closely mimic the explant pathology. Whether gene expression profiling of HCC will be refined to the point of predicting potential metastatic biologic behavior to predict post-LT recurrence will require longitudinal prospective study of this gene array technology.

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Pretransplantation Diagnosis and Staging of Hepatocellular Carcinoma in Patients with Cirrhosis: Value of Dual-Phase Helical CT

Abstract: Helical CT is a useful preoperative imaging technique in cirrhotic patients who are candidates for orthotopic liver transplantation, although it is relatively insensitive for detection of small lesions (< 2 cm).

Cited by 88 publications

References 23 publications

Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

Differentially Expressed Genes between Early and Advanced Hepatocellular Carcinoma (HCC) as a Potential Tool for Selecting Liver Transplant Recipients

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