Liver Transplantation for Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Compagnon, Philippe; Grandadam, Stéphane; Lorho, R.; Turlin, Bruno; Camus, Christophe; Yang, Jianrong; Lainé, Fabrice; Meunier, Bernard; Deugnier, Yves; Boudjéma, Karim

doi:10.1097/tp.0b013e318187754c

Cited by 37 publications

(20 citation statements)

References 62 publications

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“…Similar results were also reported in a recent study from France: a false-positive preoperative diagnosis of HCC was made for 20% of the patients. 6 The results from these studies suggest that a noninvasive diagnosis of HCC is associated with a significant false-positive rate. However, it has to be emphasized that (1) the criteria for a noninvasive diagnosis of HCC have been poorly described or (2) this diagnosis has relied solely on arterial hypervascularization.…”

mentioning

confidence: 93%

Is tumor biopsy necessary?

et al. 2011

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mentioning

confidence: 93%

Is tumor biopsy necessary?

et al. 2011

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“…Organ Sharing and the European Society for Organ Transplantation ( 4,21,26,29 ). These institutions have advocated the use of cross-sectional imaging, emphasizing MR imaging, and provide recommended criteria for diagnostic features for tumor characterization, while no longer requiring biopsy evidence of HCC for transplantation patient listing.…”

Section: Gastrointestinal Imaging: Mr Detection Of Hepatocellular Carmentioning

confidence: 99%

Hepatocellular Carcinoma Lesion Characterization: Single-Institution Clinical Performance Review of Multiphase Gadolinium-enhanced MR Imaging—Comparison to Prior Same-Center Results after MR Systems Improvements

Becker-Weidman¹,

Kalb²,

Sharma³

et al. 2011

Radiology

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Purpose:To measure diagnostic performance in the detection of hepatocellular carcinoma (HCC) by using the most recent technology and multiphase gadolinium-enhanced magnetic resonance (MR) imaging and to compare with earlier results at the same institution. Materials and Methods:This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was obtained. Between January 2008 and April 2010, 101 patients underwent liver transplantation and pretransplantation abdominal MR imaging within 90 days. Prospective image interpretations from the clinical record were reviewed for documentation of HCC, including size, number, and location. Liver explant histologic examination provided the reference standard for lesion analysis and was performed in axial gross slices in conjunction with the MR imaging report for direct comparison. Tumors were categorized according to size ( Ն 2 cm or , 2 cm), and MR imaging detection sensitivity, specifi city, predictive values, and accuracy were calculated according to category. The Fisher exact test was used to compare results from this study against prior reported results. Results:Thirty-fi ve (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specifi city of 97.1% (34 of 35) and 100% (66 of 66), respectively. For lesions 2 cm or larger, MR imaging had a sensitivity and specifi city of 100% (23 of 23) and 100% (78 of 78), respectively. For lesions smaller than 2 cm, MR imaging had a sensitivity and specifi city of 82.6% (19 of 23) and 100% (78 of 78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53 of 58) in the current study, compared with 77.8% in 2007 ( P = .07). For lesions smaller than 2 cm, the sensitivity was 87.5% (28 of 32) in the current study, compared with 55.6% previously ( P = .02). Conclusion:MR imaging remains a highly accurate diagnostic method for the preoperative evaluation of HCC, and detection of small ( , 2 cm) tumors has been signifi cantly improved compared with that of earlier studies.q RSNA, 20111 From the Departments of Radiology

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“…For those patients who have undergone transplantation, the postoperative staging should include pathological features, which are obviously not available before transplantation and thus cannot be used for determining a patient's suitability for transplantation or allocation. In addition, up to 30% of patients who are diagnosed with HCC by preoperative imaging or AFP levels have alternative histological diagnoses and should thus be down-staged, [54][55][56] and many small HCCs that are detected by pathological examinations are not diagnosed preoperatively (mostly small lesions with little impact on survival). 57,58 Although the decision to perform transplantation or to consider a patient within the criteria for transplantation may be based on the imaging stage, the new TNM staging system by definition includes the results of a pathological examination.…”

Section: What Staging System Is Best For Determining the Prognosis Afmentioning

confidence: 99%

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

et al. 2011

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Liver Transplantation for Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Cited by 37 publications

References 62 publications

Is tumor biopsy necessary?

Is tumor biopsy necessary?

Hepatocellular Carcinoma Lesion Characterization: Single-Institution Clinical Performance Review of Multiphase Gadolinium-enhanced MR Imaging—Comparison to Prior Same-Center Results after MR Systems Improvements

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

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