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- Title
Contrast imaging techniques to diagnose hepatocellular carcinoma in cirrhotics outside regular surveillance.
- Authors
Iavarone, Massimo; Viganò, Mauro; Piazza, Nicole; Occhipinti, Vincenzo; Sangiovanni, Angelo; Maggioni, Marco; D'Ambrosio, Gioacchino; Forzenigo, Laura V.; Motta, Fabio; Lampertico, Pietro; Rumi, Maria-Grazia; Colombo, Massimo
- 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%) <5 cm. 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 ≥5 cm HCC. Sensitivity of AFP >200 ng/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.
- Subjects
HEPATOCELLULAR carcinoma; NEEDLE biopsy; CONTRAST media; DIAGNOSIS methods; CIRRHOSIS of the liver; MAGNETIC resonance imaging; CANCER diagnosis
- Publication
Annals of Hepatology: Official Journal of the Mexican Association of Hepatology, 2019, Vol 18, Issue 2, p318
- ISSN
1665-2681
- Publication type
Article
- DOI
10.1016/j.aohep.2018.09.002