Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

“…According to statistics, early diagnosis of HCC is difficult due to its insidious onset. The incidence of HCC in China accounts for more than 55% worldwide . Only 30%‐40% of HCC patients can receive radical treatment, which seriously threatens people's life and health …”

“…The incidence of HCC in China accounts for more than 55% worldwide. 3 Only 30%-40% of HCC patients can receive radical treatment, which seriously threatens people's life and health. 4 The highest liver cancer rates are found in East and Southeast Asia and in Middle and Western Africa.…”

Prognostic analysis of histopathological images using pre-trained convolutional neural networks: application to hepatocellular carcinoma

“…Histopathology assessment is mandatory in HCC diagnosis (Rastogi, 2018), and the characteristics such as tumor number, size, cell differentiation and grade, and presence of satellite nodules were reported to be prognostic biomarkers (Qin, 2002). Given a histopathological image, CNNs enable efficient feature extraction and representation using convolutional, pooling, and fully connected network layers.…”

The Rise in the Prevalence of Nonalcoholic Fatty Liver Disease and Hepatocellular Carcinoma

“…It is also the most rapidly rising cause of cancer and 13 The Rise in the Prevalence of Nonalcoholic Fatty Liver Disease and Hepatocellular Carcinoma DOI: http://dx.doi.org /10.5772/intechopen.85780 cancer-related deaths with an incidence that has more than tripled over the last two decades. This high mortality reflects a poor prognosis and a poorer therapeutic intervention [147]. Compared to HCC caused by alcoholic liver disease and viral hepatitis, there is a lack of strong epidemiological data associated with the incidence and prevalence of HCC precipitating from NAFLD [140,148].…”