False Positive Diagnosis of Hepatocellular Carcinoma in Liver Resection Patients

Abstract

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors < 1 cm with two or more image findings consistent with HCC with persistently increased serum alpha-fetoprotein (AFP) levels above the normal range with underlying inhibited hepatitis activity underwent liver resection. The false-positive rate was 2.2% (n = 18). Of the 18 patients, 7 patients (0.8%) were diagnosed with benign conditions (one each of hemangioma, inflammation, cortical adenoma, dysplastic nodule, angiomyolipoma, bile duct adenoma, and non-neoplastic liver parenchyme) and 11 patients (1.3%) were diagnosed with malignancies (cholangiocarcinoma [n = 6], hepatoblastoma [n = 2], and one each of lymphoepithelioma-like carcinoma, ovarian cystadenocarcinoma, and nasopharynx carcinoma metastasis). The clinical characteristics of pathologically diagnosed HCC patients were similar (P > 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.

Results of Immunohistochemistry in the Differential Diagnosis of Early Hepatocellular Carcinoma and Nodules With High-Grade Dysplasia in Patients With Cirrhosis

“…Similar results were also found in a French study, where the false-positive diagnosis of HCC in pre-transplants occurred in 20% of the patients (33) . On the other hand, a false-positive rate <3% was detected in a cohort of Asian patients after liver resection (34) .…”

Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report

“…Serum markers are frequently used in the evaluation of liver tumors, with HCC and CC typically showing an increase in serum AFP and CA19-9, respectively. False positive elevations are well represented in the literature[ 3 , 12 , 13 ]. Increase in the AFP-L3 percentage has been shown to be relatively specific for HCC[ 14 ].…”

Hidden Carcinoma: Pitfalls in the Diagnosis of Lymphoepithelioma-Like Cholangiocarcinoma

“…15 Although the false-positive rate for imaging diagnosis of hepatocellular carcinoma without histologic confirmation is only 2.2%, in one cohort lymphoepithelioma-like cholangiocarcinoma was one of the malignant entities misdiagnosed as hepatocellular carcinoma. 16 Case 1 illustrates how the radiologic difficulty in diagnosing lymphoepithelioma-like cholangiocarcinoma extends to the grossing bench. On initial magnetic resonance cholangiopancreatography, the patient was found to have a portocaval nodal mass and nonspecific lymphadenopathy.…”