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Ann Hepatol. 2019 Mar - Apr;18(2):318-324. doi: 10.1016/j.aohep.2018.09.002. Epub 2019 Apr 17.

Contrast imaging techniques to diagnose hepatocellular carcinoma in cirrhotics outside regular surveillance.

Author information

1
C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy. Electronic address: massimo.iavarone@gmail.com.
2
Hepatology Unit, Ospedale San Giuseppe, Università di Milano, Milan, Italy.
3
C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy.
4
Department of Pathology, Fondazione IRCCS Ca' Granda, Milan, Italy.
5
Department of Pathology, Ospedale Multimedica, Milan, Italy.
6
Radiology Unit, Fondazione IRCCS Ca' Granda, Milan, Italy.
7
Radiology Unit, Ospedale San Giuseppe, Milan, Italy.
8
Center for Translational Hepatology Research, Clinical and Research Center Humanitas Hospital, Rozzano, Italy.

Abstract

INTRODUCTION AND AIM:

The American Association for the Study of the Liver (AASLD) recommends contrast computerized tomography (CT-scan) and magnetic resonance (MRI) to diagnose hepatocellular carcinoma (HCC) arising in cirrhotic patients under semiannual surveillance with abdominal ultrasound (US). A US guided fine needle biopsy (FNB) serves the same purpose in radiologically undiagnosed tumors and incidentally detected nodules in cirrhotics outside surveillance. In this population, we evaluated the performance of radiological diagnosis of HCC according to 2010 AASLD recommendations.

MATERIALS AND METHODS:

All cirrhotic patients with a liver nodule incidentally detected by US were prospectively investigated with a sequential application of CT-scan/MRI examination and a FNB.

RESULTS:

Between 2011 and 2015, 94 patients (mean age 67 years) had a liver nodule (total 120) detected by US in the context of histologically confirmed cirrhosis. Mean nodules diameter was 40 (10-160) mm, 87 (73%) <5cm. At histology, 84 (70%) nodules were HCC, 8 (7%) intrahepatic cholangiocarcinoma, 6 (5%) metastases, 2 (2%) neuroendocrine tumors and 20 (16%) benign lesions. Hyperenhancement in arterial phase followed by wash-out in venous phases on at least one radiological technique was demonstrated in 62 nodules (61 HCC, 1 high grade dysplastic nodule), with a specificity of 97% (IC95%: 85-100%), sensitivity 73% (IC95%: 62-81%) and diagnostic accuracy 80%, being 64% for ≥5cm HCC. Sensitivity of AFP >200ng/mL was 12% (IC95%: 6-23%).

CONCLUSION:

A single contrast imaging technique showing a typical contrast pattern confidently identifies HCC also in cirrhotic patients with an incidental liver nodule, thereby reducing the need for FNB examinations.

KEYWORDS:

Abdominal ultrasound; Contrast-enhanced CT-scan; Fine needle liver biopsy; Intra-hepatic cholangiocarcinoma; Magnetic resonance

PMID:
31036496
DOI:
10.1016/j.aohep.2018.09.002
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