Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Abstract

Background & Aims Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. Methods All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double‐blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. Results A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. Conclusions In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma.

Micronvasive behaviour of single small hepatocellular carcinoma: which treatment?

“…In a previous study [15], we have demonstrated that IOUS is able to detect the features of MI-HCC and these findings strongly correlated with histopathologic criteria. These IOUS findings are important to knowledge the biological behavior of HCC and to predict the risk of longterm recurrence and overall survival rates.…”

“…Number of HCC nodules was also registered: in this case, IOUS pattern has been determined for the largest nodule. As described in our previous article [15], MI-HCC was defined as a tumor with vascular/biliary infiltration and/or the presence of satellites (Fig. 1).…”

“…Recent studies have shown that contrastenhanced CT [12], diffusion-weighted magnetic resonance imaging (MRI) [13] and contrast-enhanced ultrasound [14] could be useful to predict the histological grade and/or the presence of MI, but these techniques using radiomics score are difficult to apply in the clinical practice. On the other hand, our recent study [15] suggested that patterns of aggressive behavior (MI-HCC) could be identified by the intraoperative ultrasound (IOUS) evaluation influencing the intraoperative treatment plan with respect to laparoscopic and open surgical intervention. In this prospective double-blind study, we showed that IOUS patterns of aggressive behavior correlate with both the presence of the same histological patterns and differentiation grade of HCC on the histologic specimen of the primary resected tumor.…”

Prediction of the degree of pathological differentiation in tongue squamous cell carcinoma based on radiomics analysis of magnetic resonance images

“…The degree of pathological differentiation re ects the extent of the malignancy [10]. The poorer the differentiation, the more disordered the tissue and vascular structure and the higher the risk of cancer cells invading the surrounding tissues [11]. Given that biomarkers seen on an MRI may re ect the heterogeneity of cancerous tissue, texture analysis of a single biomarker may have increased sensitivity and speci city [12].…”

Thermal ablation versus wedge or segmental resection in patients with early stage hepatocellular carcinoma: a population survival analysis

“…8,9 Further complicating this discussion, detection of micro-invasive disease pre-operatively remains challenging. Intra-operative ultrasound (IOUS), used frequently with superior detection of microinvasive disease compared to other pre-operative imaging modalities, 10 can result in expanded resection margins intraoperatively. We were interested in evaluating if type of resectionas stratified by wedge, single, two or three-segment resection would demonstrate the long term overall survival benefit of resection seen in prior retrospective reviews 11,12 when stratified by liver impairment and tumor size.…”