Subcentimeter hypervascular nodules with typical imaging findings of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: Outcomes of early treatment and watchful waiting

Woo, Jung Han; Song, Kyoung Doo; Kim, Seong Hyun

doi:10.1007/s00330-017-4818-8

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…Woo et al reported that recurrence-free survival does not differ significantly between early treatment and watchful waiting for sub-centimeter hypervascular nodules with usual imaging features of HCC on MRI [16]. The mean size of nodules at treatment in their research was 7.4 mm for the early treatment group and 11.2 mm for the watchful waiting group.…”

Section: Discussionmentioning

confidence: 92%

“…To date, there have been few articles reporting treatment efficiency for primary sub-centimeter HCCs. Only 1 study, which included 63 patients with or without a history of HCC, has reported that recurrence-free survival does not differ significantly between patients who were treated with nodules <1 cm and those with nodules ≥1 cm [16]. To the best of our knowledge, the survival benefits have not been proven for patients with primary sub-centimeter HCCs who received local ablation (LA), surgical resection (SR) or liver transplantation (LT) compared with patients with HCCs that are in the 1 to 2 cm range.…”

Section: Introductionmentioning

confidence: 99%

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The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?

et al. 2019

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Background The optimal strategy for dealing with sub-centimeter hepatic nodules has not yet been established. This study aimed to assess whether there was a need to provide curative treatments for sub-centimeter hepatocellular carcinomas (HCCs) to patients at risk for high false positives. Material/Methods We identified patients with primary pathologically diagnosed HCC ≤2 cm from 2004 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database. They were divided according to the interventions they received: local ablation, surgical resection, or liver transplantation. In each group, overall survival and cancer-specific survival were used as endpoints to compare the prognoses between patients with sub-centimeter HCC and patients with HCC measuring 1 to 2 cm by Kaplan-Meier. Propensity score matching was performed to reduce bias. We also compared the survival of patients with a primary solitary HCC based on interventions, in the different tumor size groups. Bootstrapping was performed to validate the findings. Results Overall, 10.4% of patients (197 out of 1894) had HCCs <1 cm, and 89.6% of patients (1697 out of 1894) had HCCs in the 1 to 2 cm range. There was no significant difference in overall and cancer-specific survival between patients with HCCs <1 cm and those with HCCs in the 1 to 2 cm range, in all treatment groups. After adjusting confounding factors, no significant correlation was found between tumor size and survival time. In patients with HCCs measuring ≤2 cm, overall survival and cancer-specific survival were superior in liver transplantation compared with surgical resection and local ablation. Surgical resection provided better survival than local ablation. Conclusions Compared to patients with HCCs measuring 1 to 2 cm, the survival rates of patients with sub-centimeter HCCs was not improved through curative treatments, risking high false positives.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?

et al. 2019

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“…The confirmation of recurrent HCC was based on histology (surgical resection, liver transplantation, or percutaneous biopsy) or on follow‐up MRI: Nodules >10 mm in size that showed nonrim arterial phase hyperenhancement (APHE) with threshold growth (≥50% size increase in ≤6 months) were categorized as LR‐5 in LI‐RADS version 2018 Nodules with a subcentimeter size that showed typical imaging hallmarks of HCC (nonrim APHE, washout, mild‐moderate T 2 hyperintensity, restricted diffusion, and HBP hypointensity) with increasing intervals in size to larger than 10 mm …”

Section: Methodsmentioning

confidence: 99%

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Wang¹,

Yang²,

Zhu

et al. 2020

Liver Transpl

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Small recurrent hepatocellular carcinoma (HCC) can show atypical imaging patterns, and a specific diagnostic algorithm for HCC is lacking. This study aimed to better characterize postoperative recurrent HCCs <20 mm in size with gadoxetic acid-enhanced magnetic resonance imaging (MRI). We evaluated 373 newly developed nodules after hepatectomy in 204 HCC patients with chronic hepatitis B virus infection. The diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) version 2018 was calculated with gadoxetic acid-enhanced MRI to characterize recurrent HCC. Modified diagnostic algorithms were proposed by combining significant imaging biomarkers related to subcentimeter and 10-19 mm recurrence, and the algorithms were then compared with the LI-RADS system. A total of 256 recurrent HCCs (108 recurrent HCCs <10 mm in size; 148 recurrent HCCs 10-19 mm in size) were confirmed via histology or follow-up imaging. Nonrim arterial phase hyperenhancement (APHE) and 3 LI-RADS ancillary features (AFs; hepatobiliary phase hypointensity, mildmoderate T 2 hyperintensity, and restricted diffusion) were significantly related to recurrent HCCs <20 mm in size according to a multivariate analysis. For subcentimeter recurrence, combining at least 2 of the 3 AFs only achieved better specificity (sensitivity, 83.3%; specificity, 87.7%) than the LR-4 category (sensitivity, 88.9%, P = 0.21; specificity, 70.8%, P = 0.006). For 10-19 mm recurrences, combining nonrim APHE and at least 1 of the 3 AFs achieved only a significantly enhanced sensitivity of 85.1% but a lower specificity of 86.5% compared with the LR-5 category (sensitivity: 63.5%, P < 0.001; specificity: 94.2%, P = 0.13). In conclusion, the diagnostic algorithms for subcentimeter and 10-19 mm recurrent HCCs should be stratified. Combining at least 2 AFs demonstrated comparable sensitivity with significantly enhanced specificity compared with the LR-4 category for characterizing subcentimeter recurrence. Liver Transplantation 26 751-763 2020 AASLD.Recurrence of hepatocellular carcinoma (HCC) after hepatectomy is a common issue that occurs in more than 70% of patients at 5 years. (1,2) Dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are commonly performed to establish further evaluation of indeterminate observations. Repeated hepatic resection, liver transplantation, and thermal ablation are recommended for treating recurrent HCCs. (3,4) In particular, percutaneous ultrasound (US)/MRI fusion-guided thermal ablation are safe and effective treatment modalities for subcentimeter recurrent HCC. (5) Indeterminate nodules <20 mm in size are probably benign in screening populations Wang et al.

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“…Until now, there have been no solid data assessing whether immediate treatment or a wait-and-see strategy should be followed to achieve better outcomes in patients with sub-centimeter recurrent HCC. According to a recent study[36], recurrence-free survival in patients with sub-centimeter HCC did not vary between immediate treatment and wait-and-see groups. However, the previous study is limited by its retrospective study design and small sample size.…”

Section: Management Of Sub-centimeter Recurrent Hccmentioning

confidence: 99%

Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future

Lee

Lim

2018

WJG

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Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.

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Subcentimeter hypervascular nodules with typical imaging findings of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: Outcomes of early treatment and watchful waiting

Abstract: • Recurrence-free survival did not vary between the two treatment strategies. • Treatment modality was a significant factor for local recurrence-free survival. • Number of treatments, tumour number, and α-FP were risk factors for recurrence.

Cited by 15 publications

References 22 publications

The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?

The Optimal Management for Sub-Centimeter Hepatocellular Carcinoma: Curative Treatments or Follow-Up?

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future

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