Should we biopsy each liver mass suspicious for hepatocellular carcinoma before liver transplantation?–Yes

Marsh, J. Wallis; Dvorchik, Igor

doi:10.1016/j.jhep.2005.07.014

Cited by 27 publications

(14 citation statements)

References 21 publications

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“…Several alternative approaches to tumor number and size for recurrence risk stratification have been proposed. Perhaps the most promising so far has emerged from the University of Pittsburgh, which, by means of a genomic strategy on explanted livers containing HCC, has shown that analysis for loss of heterozygosity in specific microsatellite DNA regions is highly predictive of posttransplantation recurrence 43–45. The retrospective nature of the analysis, the requirement for HCC tissue, the possibility of biopsy complications including needle track seeding46–47 and the potential for sampling error, particularly if based on pretransplantation biopsy material rather than explanted or resected specimens, are the major limitations of this approach.…”

Section: What Are Acceptable Outcomes That Justify Use Of a Scarce Rementioning

confidence: 99%

Allocation policy for hepatocellular carcinoma in the MELD era: Room for improvement?

Roayaie

Feng

2007

Liver Transpl

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Section: What Are Acceptable Outcomes That Justify Use Of a Scarce Rementioning

confidence: 99%

Allocation policy for hepatocellular carcinoma in the MELD era: Room for improvement?

Roayaie

Feng

2007

Liver Transpl

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“…Diagnosis of liver cancer or space-occupying lesions is a traditional application for the liver biopsy and remains useful today, especially before the liver transplantation. 1 However, there are several disadvantages of liver biopsy in clinic. Firstly, biopsy for suspicious liver lesions has risks such as bleeding, bile leak, tumor dissemination, and needle track seeding.…”

Section: Introductionmentioning

confidence: 99%

Preclinical study of using multiphoton microscopy to diagnose liver cancer and differentiate benign and malignant liver lesions

et al. 2012

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Abstract. Recently, the miniaturized multiphoton microscopy (MPM) and multiphoton probe allow the clinical use of multiphoton endoscopy for diagnosing cancer via "optical biopsy". The purpose of this study was to establish MPM optical diagnostic features for liver cancer and evaluate the sensitivity, specificity, and accuracy of MPM optical diagnosis. Firstly, we performed a pilot study to establish the MPM diagnostic features by investigating 60 surgical specimens, and found that high-resolution MPM images clearly demonstrated apparent differences between benign and malignant liver lesions in terms of their tissue architecture and cell morphology. Cancer cells, characterized by irregular size and shape, enlarged nuclei, and increased nuclear-cytoplasmic ratio, were identified by MPM images, which were comparable to hematoxylin-eosin staining images. Secondly, we performed a blinded study to evaluate the sensitivity, specificity, and accuracy of MPM optical diagnosis by investigating another 164 specimens, and found that the sensitivity, specificity, and accuracy of MPM diagnosis was 96.32%, 96.43%, and 96.34%, respectively. In conclusion, it is feasible to use MPM to diagnose liver cancer and differentiate benign and malignant liver lesions. This preclinical study provides the groundwork for further using multiphoton endoscopy to perform real-time noninvasive "optical biopsy" for liver lesions in the near future.

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“…The HCC classification by the OPTN system no longer includes mandatory diagnostic criteria for nodules measuring <1 cm because of the difficulty in characterizing them accurately . However, the presence of actual HCCs, per se, even if they are very small, is incorporated into all transplant criteria worldwide in relation to post‐LT prognosis so that the allocation of LT can be fairly and accurately decided . Our study was performed under the premise that the LT setting included hepatic nodules of any size, and we found that all of 3 arterial‐enhancing lesions of <1 cm with portal washout were HCCs, which is a greater proportion than in the published data .…”

Section: Discussionmentioning

confidence: 91%

Hepatocyte‐Specific Magnetic Resonance Imaging–Based Assessment of Indeterminate Hepatic Nodules in the Liver Transplant Evaluation of Patients With Cirrhosis

et al. 2020

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We aimed to determine the identities in explants of indeterminate hepatic nodules (IDNs) that had been scanned by dynamic magnetic resonance imaging (MRI) to establish clinicoradiological parameters predicting which IDNs were hepatocellular carcinomas (HCCs). This study included 88 patients with cirrhosis who underwent gadoxetic acid–enhanced MRI in pre–liver transplantation (LT) workup followed within 90 days by primary LT. The MRI detected 168 hepatic nodules that were classified into 6 benign tumors, 49 HCCs, and 113 IDNs, in 5, 34, and 72 patients, respectively. We compared these pre‐LT radiologic diagnoses and stagings with explant pathology on a per‐lesion basis to enable us to identify features of IDNs related to malignancy. Of the 168 nodules seen on MRI, 119 that were classified radiologically as consisting of 1 benign nodule (33.3%), 46 HCCs (93.9%), and 72 IDNs (63.7%) all turned out to be pathological HCCs. Of 32 patients inside Milan and 54 without HCC staged by MRI, 11 progressed beyond the criteria after LT. High serum alpha‐fetoprotein level (≥20 ng/mL) was the only per‐patient factor significantly associated with malignant IDNs. Per‐tumor analysis of the MRI signals revealed that arterial hyperintensity, hepatobiliary hypointensity, T2‐weighted mild‐to‐moderate intensity, and restricted diffusion‐weighted images were significantly correlated with malignant IDN. A model combining these 4 MRI factors with alpha‐fetoprotein level had the best performance in predicting the identification of IDNs as HCCs in explanted livers. Over 60% of the IDNs seen on dynamic images of cirrhotic livers proved to be HCCs when explanted livers were examined. It may therefore be possible to identify HCCs with reasonable accuracy by means of their hepatocyte‐specific MRI features when patients are being assessed for LT.

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Should we biopsy each liver mass suspicious for hepatocellular carcinoma before liver transplantation?–Yes

Cited by 27 publications

References 21 publications

Allocation policy for hepatocellular carcinoma in the MELD era: Room for improvement?

Allocation policy for hepatocellular carcinoma in the MELD era: Room for improvement?

Preclinical study of using multiphoton microscopy to diagnose liver cancer and differentiate benign and malignant liver lesions

Hepatocyte‐Specific Magnetic Resonance Imaging–Based Assessment of Indeterminate Hepatic Nodules in the Liver Transplant Evaluation of Patients With Cirrhosis

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