Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations

Abstract

Imaging detection and diagnosis of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) in cirrhotic patients is important because the number, size, and type of focal lesions strongly influence patient management. Focal lesions detected by imaging examinations during pretransplantation evaluation were correlated with focal lesions detected during detailed pathological examination of 49 cirrhotic explant livers. Within 6 months before transplantation, color Doppler ultrasonography (US), contrast-enhanced computed tomography (CT), and magnetic resonance (MR) imaging were performed in 94%, 33%, and 55% of patients, respectively. In 2% to 8% of patients, different types of benign focal lesions were present, and a considerable proportion was interpreted as (pre)malignant on imaging examination. US detected only the largest HCCs (patient sensitivity, 40%; specificity, 100%) and no DNs. On a per-patient basis, contrastenhanced CT and MR imaging had poor sensitivity (20% and 27%, respectively) and good specificity (100% and 94%, respectively) for DNs. Patient sensitivity and specificity of both techniques for HCC were reasonable (50% for CT, 70% for MR imaging) and good (79% for CT, 82% for MR imaging), respectively. Neither technique was able to detect smaller (pre)malignant lesions. As a consequence, 10% of patients underwent transplantation, although they exceeded the tumor number limit. Currently used imaging techniques cannot correctly determine the exact tumor burden in some cirrhotic patients. Regular contrast-enhanced MR examination of cirrhotic patients waiting for liver transplantation is the best tool for the early detection of (pre)malignant lesions. (Liver Transpl 2002;8:749-761.)

Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN database

“…This possibility is supported by data from the Netherlands, where a retrospective correlation of liver histology with pretransplant imaging in which the radiologists were not aware of a clinical study, demonstrated an overall sensitivity for MRI (70%) and CT (50%), similar to our study. 15 Our data, though potentially biased (see discussion below), is likely more indicative of common practice. We could not evaluate different CT or MRI techniques as these details of scan methodology are not captured in the UNOS/OPTN database.…”

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

“…We conducted a meta-analysis of the sensitivity and specificity of AFP, US, spiral CT and MRI for HCC diagnosis in CHB patients using Meta-Disc (Zamora et al, 2006). A total of 19 studies were considered for the analysis (Maringhini et al, 1984;Okazaki et al, 1984;Kobayashi et al, 1985;Gambarin-Gelwan et al, 2000;Lim et al, 2000;Peterson et al, 2000;Kim, et al, 2001;Krinsky, et al, 2001;Rode et al, 2001;Tong et al, 2001;Trevisani et al, 2001;Bennett et al, 2002;de Ledinghen et al, 2002;Libbrecht et al, 2002;Mori et al, 2002;Zacherl et al, 2002;Bhartia et al, 2003;Burrel et al, 2003;Marrero et al, 2003).…”

Is tumor biopsy necessary?

“…Eleven studies in this systematic review analyzed the accuracy of CT for the diagnosis of HCC [33][34][35]37,40,43,46,[48][49][50][51] (Supporting Table 5). Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard.…”

“…Finally, 9 studies used MRI for the noninvasive diagnosis of HCC 32,40,43,46,48,[52][53][54][55] (Supporting Table 6). In all *The analysis was presented for 3 observers.…”