Percutaneous ultrasound-guided fine-needle aspiration of portal vein thrombi as a diagnostic and staging technique for hepatocellular carcinoma

Rammohan, Ashwin; Sathyanesan, Jeswanth; Sukumar, R; Lakshmanan, Anand; Kumar, Prashant; Srinivasan, U.; Ramakrishnan, Ravi; Ravichandran, Palanisamy

doi:10.1007/s00261-013-9997-4

Cited by 13 publications

(10 citation statements)

References 9 publications

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“…Percutaneous US-guided fine-needle aspiration is another simple, safe and effective diagnostic method to distinguish non-neoplastic and neoplastic portal thrombosis when a definitive diagnosis is not attained by imaging methods[28].…”

Section: Diagnostic Approach To Pvttmentioning

confidence: 99%

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Cerrito

Annicchiarico

Iezzi

et al. 2019

WJG

104

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Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient’s clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.

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Section: Diagnostic Approach To Pvttmentioning

confidence: 99%

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Cerrito

Annicchiarico

Iezzi

et al. 2019

WJG

104

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“…Differentiation of tumor PVT from bland PVT may be challenging, and definitive diagnosis often relies on fine-needle biopsy of the thrombus. (10)(11)(12)(13) However, fine-needle biopsy is an invasive procedure and may be contraindicated in the setting of coagulopathy and/ or ascites. Noninvasive diagnostic strategies are preferred to determine the etiology of PVT, but specific criteria are not well established.…”

Section: See Editorial On Page 201mentioning

confidence: 99%

“…Differentiation of tumor PVT from bland PVT may be challenging, and definitive diagnosis often relies on fine‐needle biopsy of the thrombus . However, fine‐needle biopsy is an invasive procedure and may be contraindicated in the setting of coagulopathy and/or ascites.…”

mentioning

confidence: 99%

Distinguishing Tumor From Bland Portal Vein Thrombus in Liver Transplant Candidates With Hepatocellular Carcinoma: the A‐VENA Criteria

et al. 2019

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Differentiating tumor versus bland portal vein thrombosis (PVT) is essential in determining liver transplantation (LT) candidacy for patients with hepatocellular carcinoma (HCC). We aimed to evaluate radiographic and clinical features that could noninvasively distinguish tumor PVT from bland PVT in HCC patients. Of 467 patients with HCC listed for LT from 2004 to 2011, 59 (12.6%) had PVT and 12 of 59 (20.3%) were deemed malignant. When comparing tumor versus bland PVT, thrombus enhancement was seen in 100% versus 8.5%; venous expansion was seen in 91.7% versus 10.6%; neovascularity was seen in 58.3% versus 2.1%; and being adjacent to HCC or prior treatment site was seen in 100% versus 21.3% (all P < 0.001). Combining these 4 imaging characteristics with alpha‐fetoprotein (AFP) >1000 ng/dL, the presence of ≥3 criteria best characterized tumor PVT with 100% sensitivity, 93.6% specificity, 80% positive predictive value, and 100% negative predictive value. No LT recipients with presumed bland PVT had macrovascular invasion on explant. There were no differences in post‐LT survival or HCC recurrence with bland PVT versus no PVT. In conclusion, we proposed noninvasive criteria that could accurately differentiate tumor PVT from bland PVT called A‐VENA, which is based on the presence of ≥3 of the following: AFP >1000 ng/dL; venous expansion; thrombus enhancement; neovascularity; and adjacent to HCC. Use of the A‐VENA criteria can assist in standardizing the evaluation of PVT in patients with HCC being considered for LT.

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“…HCC invasion into the portal vein or extrahepatic vascular metastasis affects patient survival and changes the approach of management by precluding many treatment modalities, such as liver transplantation, surgical resection, ablation, or chemoembolization, which are usually associated with a high recurrence rate. Therefore, the recognition of PVT and accurate differentiation of bland from malignant thrombus are crucial for patient management [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma

et al. 2021

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Background/Aims: Malignant portal vein thrombus (PVT) is found in up to 44% of patients with hepatocellular carcinoma (HCC). The nature of the thrombus influences treatment selection. The aim of this study was to assess the safety and efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in determining the nature of PVT in liver cirrhosis and/or HCC.Methods: A prospective study was conducted in 34 patients with liver cirrhosis and/or HCC with PVT. Under EUS guidance, PVT was punctured using a 22 G FNA needle (Cook Medical, Bloomington, IN, USA) followed by monitoring of the puncture tract using color Doppler. Patients were followed for adverse events 2 hours after recovery.Results: Throughout the 30-month study period, 34 patients, including 24 males with a mean age of 59±8 years, were enrolled. There were 8 patients with known HCC and 26 with no liver masses detected by computed tomography (CT). EUS-FNA from PVT was positive for malignancy in 3 patients (8.8%), of which only 1 patient was diagnosed with HCC by CT and 2 patients were newly diagnosed with HCC after EUS-FNA. No major complications were reported.Conclusions: EUS-FNA is a safe and effective technique for determining the nature of PVT that does not fulfill the malignant criteria via imaging studies in patients with liver cirrhosis and/or HCC.

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Percutaneous ultrasound-guided fine-needle aspiration of portal vein thrombi as a diagnostic and staging technique for hepatocellular carcinoma

Abstract: FNAC of PVT is a simple, safe, effective, well-tolerated, and economical method for staging of patients with HCC. When used as the initial diagnostic procedure, in selected patients, it can provide the diagnosis and staging information simultaneously.

Cited by 13 publications

References 9 publications

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Distinguishing Tumor From Bland Portal Vein Thrombus in Liver Transplant Candidates With Hepatocellular Carcinoma: the A‐VENA Criteria

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma

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