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Jornet-Rius O, Agulla B, López MC, Viñeta C, García-Ferrer A, Serrano B, Marco A, Palomares A, Novellas R, Espada Y, Roura X, Solano-Gallego L. Needle tract seeding and malignant transformation of hepatocellular adenoma into well-differentiated hepatocellular carcinoma in a dog. Vet Clin Pathol 2023; 52:507-513. [PMID: 37202832 DOI: 10.1111/vcp.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 05/20/2023]
Abstract
An 11-year-old neutered female Golden Retriever was referred for investigation of marked increases in liver enzyme activities. Abdominal ultrasound revealed a large pedunculated liver mass. Diagnosis of hepatocellular adenoma (HCA) was made when the mass was excised after a first unsuccessful attempt through ultrasound-guided core-needle biopsy. One and a half years after presentation, a nodule embedded between muscles of the abdominal wall appeared. The mass was first diagnosed as a well-differentiated hepatocellular carcinoma (HCC) through cytologic examination, which was later confirmed with histopathology. Ki 67 immunostaining of the abdominal wall nodule showed an increased immunoreactivity compared with the liver mass. Therefore, the present case documents the first needle-tract seeding of a hepatocellular epithelial tumor with possible malignant transformation of HCA into a well-differentiated HCC in a dog.
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Affiliation(s)
- Oriol Jornet-Rius
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Agulla
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Claudia Viñeta
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Bárbara Serrano
- Servei de Diagnòstic de Patologia Veterinària, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto Marco
- Servei de Diagnòstic de Patologia Veterinària, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Palomares
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Novellas
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yvonne Espada
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Roura
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Solano-Gallego
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kobayashi N, Yoshida H, Fujikawa N, Yoshimachi S, Kohyama A, Kawaguchi S. Diagnostic utility of EUS-FNA in distinguishing hepatocellular carcinoma from gastric submucosal tumor: A case report. Int J Surg Case Rep 2023; 110:108715. [PMID: 37633197 PMCID: PMC10509792 DOI: 10.1016/j.ijscr.2023.108715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Extrahepatically growing hepatocellular carcinoma (HCC) account for only 0.3 %-2.4 % of all hepatocellular carcinoma cases. We present the rare case of a patient in whom endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was used to distinguish an extrahepatically growing HCC from a gastric submucosal tumor. CASE PRESENTATION The patient was a 44-year-old man who underwent an esophagogastroduodenoscopy (EGD) and was found to have a submucosal tumor (SMT). A gastrointestinal stromal tumor was suspected. Computed tomography (CT) showed an unclear connecting between the tumor and the liver. On immunohistochemical analysis, the tumor cells were positive for CK7, PIVKA-II, and glypican-3, and negative for C-kit. Based on these findings, HCC was suspected, and ethoxybenzyl diethylenetriamine-enhanced magnetic resonance imaging (EOB-MRI) was performed. EOB-MRI revealed the connecting of the tumor and the liver. Thus, the patient was diagnosed as having an extrahepatically protruding HCC, and laparoscopic S2 partial hepatectomy was performed. Pathologically, the tumor was identified as a moderately differentiated HCC. According to the 8th edition of the UICC TNM Classification, the tumor was classified as T1bN0M0 and stage IB. CLINICAL DISCUSSION Owing to its rarity, the diagnosis of an extrahepatically protruding HCC is often difficult when the differentiation of a gastric SMT and HCC is unclear on CT. As in this case, if an HCC is also differentiated on hematoxylin and eosin staining after EUS-FNA, immunohistochemistry findings can help in the diagnosis. CONCLUSION The findings show that EUS-FNA could be helpful for diagnosis when an HCC needs to be differentiated from a gastric SMT.
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Affiliation(s)
- Naoya Kobayashi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan.
| | - Hiroshi Yoshida
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Nanako Fujikawa
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shingo Yoshimachi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Atsushi Kohyama
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shinya Kawaguchi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
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Safety of percutaneous, image-guided biopsy of hepatocellular carcinoma with and without concurrent ablation. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2640-2646. [PMID: 35396970 DOI: 10.1007/s00261-022-03494-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique. METHODS In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging. Adverse events were graded using both the Clavien-Dindo Complication Classification system and the most recently proposed Society of Interventional Radiology (SIR) Adverse Event Classification System. RESULTS A total of 383 patients underwent 398 biopsies (64 ± 11 years; 112 women, 271 men). Most patients (282; 71%) underwent concurrent ablation. Adverse events occurred after 18 biopsies (4.5%): 13 were Grade I (Clavien-Dindo) or minor (SIR) and included hematoma (7), hepatic vein thrombus (2), portal vein thrombus (2), moderate pleural effusion (1), and small pneumothorax (1). The remaining 5 (1.3%) adverse events were classified as Grade II-IIIa (Clavien-Dindo) or moderate (SIR) and included hematoma requiring blood products (n = 1), arrhythmia (n = 1), and symptomatic pleural effusions requiring treatment (n = 3). Baseline age, sex, cause of liver disease, HCC diameter, and HCC grade were not associated with adverse events. There were no tumor seeding events after a median follow-up of 611 days (interquartile range of 211-1104). CONCLUSION Percutaneous image-guided tissue sampling using a standardized, indirect access, coaxial technique can be performed safely with and without concurrent ablation by trained cross-sectional interventional radiologists at a tertiary liver transplant center.
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Liao CC, Cheng YF, Yu CY, Tsang LCL, Chen CL, Hsu HW, Chang WC, Lim WX, Chuang YH, Huang PH, Ou HY. A Scoring System for Predicting Microvascular Invasion in Hepatocellular Carcinoma Based on Quantitative Functional MRI. J Clin Med 2022; 11:3789. [PMID: 35807074 PMCID: PMC9267530 DOI: 10.3390/jcm11133789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is a histopathological marker and risk factor for HCC recurrence. We integrated diffusion-weighted imaging (DWI) and magnetic resonance (MR) image findings of tumors into a scoring system for predicting MVI. In total, 228 HCC patients with pathologically confirmed MVI who underwent surgical resection or liver transplant between November 2012 and March 2021 were enrolled retrospectively. Patients were divided into a right liver lobe group (n = 173, 75.9%) as the model dataset and a left liver lobe group (n = 55, 24.1%) as the model validation dataset. Multivariate logistic regression identified two-segment involved tumor (Score: 1; OR: 3.14; 95% CI: 1.22 to 8.06; p = 0.017); ADCmin ≤ 0.95 × 10-3 mm2/s (Score: 2; OR: 10.88; 95% CI: 4.61 to 25.68; p = 0.000); and largest single tumor diameter ≥ 3 cm (Score: 1; OR: 5.05; 95% CI: 2.25 to 11.30; p = 0.000), as predictive factors for the scoring model. Among all patients, sensitivity was 89.66%, specificity 58.04%, positive predictive value 68.87%, and negative predictive value 84.41%. For validation of left lobe group, sensitivity was 80.64%, specificity 70.83%, positive predictive value 78.12%, and negative predictive value 73.91%. The scoring model using ADCmin, largest tumor diameter, and two-segment involved tumor provides high sensitivity and negative predictive value in MVI prediction for use in routine functional MR.
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Affiliation(s)
- Chien-Chang Liao
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Yu-Fan Cheng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Chun-Yen Yu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Leung-Chit Leo Tsang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Chao-Long Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan;
| | - Hsien-Wen Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Wan-Ching Chang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Wei-Xiong Lim
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Yi-Hsuan Chuang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Po-Hsun Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
| | - Hsin-You Ou
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan; (C.-C.L.); (Y.-F.C.); (C.-Y.Y.); (L.-C.L.T.); (H.-W.H.); (W.-C.C.); (W.-X.L.); (Y.-H.C.); (P.-H.H.)
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Long X, Chen Y, Chen WX, Wu Y, Song J, Chen J, Zhang L. Primary spindle cell sarcoma of gallbladder: An unusual case report and a literature review. Medicine (Baltimore) 2022; 101:e28549. [PMID: 35029216 PMCID: PMC8758010 DOI: 10.1097/md.0000000000028549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Primary spindle cell sarcoma of the gallbladder is a rare condition. PATIENT CONCERNS A 67-year-old woman was admitted to a local hospital with a chief complaint of abdominal pain in the right upper quadrant for the past 2 months. DIAGNOSIS AND INTERVENTION Surgical resection was performed following the diagnosis of primary gallbladder sarcoma with local hepatic metastasis. Histological examination confirmed a diagnosis of primary spindle cell sarcoma and hepatic metastasis with simultaneous cholecystolithiasis. OUTCOMES Adjuvant chemoradiation therapy was not performed because the patient refused treatment. Three months after the surgery, a relapsed lesion was diagnosed. The patient underwent transcatheter arterial chemoembolization. CONCLUSIONS The disease should be differentially diagnosed from gallbladder carcinoma or carcinosarcoma with hepatic metastasis. An aggressive surgical approach should be based on a balance between the risk of surgery and the outcome.
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Affiliation(s)
- Xin Long
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Chen
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei-Xun Chen
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Wu
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Song
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Chen
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Hepatobiliary Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Medical University; Shanxi Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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Jegatheeson S, Dandrieux JR, Cannon CM. Suspected pancreatic carcinoma needle tract seeding in a cat. JFMS Open Rep 2020; 6:2055116920918161. [PMID: 32537237 PMCID: PMC7268146 DOI: 10.1177/2055116920918161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Case summary A 15-year-old male neutered domestic longhair cat was referred for investigation of a pancreatic nodule. Fine-needle aspiration of the nodule was performed on two occasions, 2 weeks apart, and cytology revealed pyogranulomatous inflammation and moderately dysplastic exocrine pancreatic epithelium, suspicious for neoplasia. Thoracic radiographs were unremarkable and a partial pancreatectomy was performed. On histopathology, the nodule was diagnosed as a moderately differentiated pancreatic adenocarcinoma. Two weeks after surgery, a firm subcutaneous nodule was detected on the left ventrolateral abdomen. Cytology of the nodule was suggestive of pancreatic carcinoma and needle tract seeding was suspected. With palliative treatment, the cat lived a further 136 days. Relevance and novel information To our knowledge, this represents the first report of suspected transabdominal needle tract seeding of pancreatic carcinoma following fine-needle aspiration in veterinary medicine. Veterinarians should consider this when discussing risks of pancreatic fine-needle aspiration with owners and should attempt to minimise the number of needle aspirations where possible.
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Affiliation(s)
- Selvi Jegatheeson
- Department of Veterinary Clinical Sciences, University of Melbourne, Werribee, VIC, Australia
| | - Julien Rs Dandrieux
- Department of Veterinary Clinical Sciences, University of Melbourne, Werribee, VIC, Australia
| | - Claire M Cannon
- Department of Veterinary Clinical Sciences, University of Melbourne, Werribee, VIC, Australia
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Zhang ZG, Chen Y, Ji R, Zhao YJ, Wang J, Robinson L, Chen XP, Zhang L. Synchronous cancers of gallbladder carcinoma and combined hepatocellular cholangiocarcinoma: an unusual case and literature review. BMC Cancer 2018; 18:1046. [PMID: 30373546 PMCID: PMC6205787 DOI: 10.1186/s12885-018-4969-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Synchronous primary cancers in gallbladder and liver are rarely reported. Here we report an unusual case of synchronous cancers of gallbladder carcinoma and combined hepatocellular cholangiocarcinoma. Case presentation Several lesions in the gallbladder and in adjacent parenchyma of liver were discovered in a 65-years-old woman by imaging examination. Surgical resection was performed following a diagnosis of primary gallbladder carcinoma with local hepatic metastasis. Histological examination confirmed the diagnosis of primary gallbladder carcinoma, and the lesions in the liver consisted of hepatocellular carcinoma simultaneously with cholangiocarcinoma. Adjuvant chemoradiation therapy was not performed due to the patient’s refusal of the treatment. Unfortunately, the patient died of widespread metastasis 8 months after the operation. Conclusions The disease needed to be differentially diagnosed from gallbladder carcinoma with hepatic metastasis. Aggressive surgical approach should be based on a balance between the risk of surgery (morbidity and mortality) and the outcome.
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Affiliation(s)
- Zhan-Guo Zhang
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yan Chen
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, People's Republic of China
| | - Ran Ji
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Ya-Jie Zhao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Jian Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Lily Robinson
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Lei Zhang
- Hepatic Surgery Center, Institute of Hepato-Pancreato-Bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Rastogi A. Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma. World J Gastroenterol 2018; 24:4000-4013. [PMID: 30254404 PMCID: PMC6148422 DOI: 10.3748/wjg.v24.i35.4000] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.
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Affiliation(s)
- Archana Rastogi
- Department of Pathology, Institute of Liver & Biliary Sciences, New Delhi 110070, India
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Sparchez Z, Mocan T. Contemporary role of liver biopsy in hepatocellular carcinoma. World J Hepatol 2018; 10:452-461. [PMID: 30079131 PMCID: PMC6068845 DOI: 10.4254/wjh.v10.i7.452] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023] Open
Abstract
A correct diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy (LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities.
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Affiliation(s)
- Zeno Sparchez
- 3 Medical Department, Institute for Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Tudor Mocan
- 3 Medical Department, Institute for Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania.
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Matthew Hawkins C, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor AS, Towbin RB, Cahill AM, Lungren MP. Role of interventional radiology in managing pediatric liver tumors : Part 2: percutaneous interventions. Pediatr Radiol 2018; 48:565-580. [PMID: 29396792 DOI: 10.1007/s00247-018-4072-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/22/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
Hepatoblastoma and hepatocellular carcinoma (HCC) are the most common pediatric liver malignancies, with hepatoblastoma occurring more commonly in younger children and HCC occurring more commonly in older children and adolescents. Although surgical resection (including transplant when necessary) and systemic chemotherapy have improved overall survival rate for hepatoblastoma to approximately 80% from 30%, a number of children with this tumor type are not eligible for operative treatment. In contradistinction, pediatric HCC continues to carry a dismal prognosis with an overall 5-year survival rate of 30%. The Paediatric Hepatic International Tumour Trial (PHITT) is an international trial aimed at evaluating both existing and emerging oncologic therapies for primary pediatric liver tumors. Interventional radiology offers a number of minimally invasive procedures that aid in diagnosis and therapy of pediatric liver tumors. For diagnosis, the PHITT biopsy guidelines emphasize and recommend percutaneous image-guided tumor biopsy. Additionally, both percutaneous and endovascular procedures provide therapeutic alternatives that have been, to this point, only minimally utilized in the pediatric population. Specifically, percutaneous ablation offers a number of cytotoxic technologies that can potentially eradicate disease or downstage children with unresectable disease. Percutaneous portal vein embolization is an additional minimally invasive procedure that might be useful to induce remnant liver hypertrophy prior to extended liver resection in the setting of a primary liver tumor. PHITT offers an opportunity to collect data from children treated with these emerging therapeutic options across the world. The purpose of this manuscript is to describe the potential role of minimally invasive percutaneous transhepatic procedures, as well as review the existing data largely stemming from the adult HCC experience.
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Affiliation(s)
- C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA.
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Eric J Monroe
- Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA
| | - Avnesh S Thakor
- Department of Radiology, Lucille Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew P Lungren
- Department of Radiology, Lucille Packard Children's Hospital, Stanford University, Stanford, CA, USA
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Song KD, Rhim H, Lee MW, Kang TW, Lim S. A radiofrequency device for tract ablation after liver biopsy: a single-institution human feasibility study. Br J Radiol 2018; 91:20170585. [PMID: 29356562 DOI: 10.1259/bjr.20170585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The need for liver biopsy has been increasing because genetic testing of specimens has become important for determining prognosis and management in patients with hepatic malignancy. We evaluated the feasibility of a device for biopsy tract ablation in patients with hepatic masses. METHODS This prospective single-center pilot study was approved by our institutional review board and patients provided written informed consent. Between September 2015 and March 2016, 10 patients (6 males and 4 females, 35-66-years-old) who had hepatic masses and normal range of platelet count and prothrombin time were enrolled. After percutaneous ultrasound-guided biopsy, the biopsy tract was ablated with the device which consists of an insulation sheath and a radiofrequency applicator. Complications were evaluated with Doppler ultrasound immediately after the biopsy, with noncontrast abdominopelvic CT the day after the biopsy, and with a telephone interview 7 days after the biopsy. RESULTS Tract ablation did not cause any pain in seven patients and caused minimal pain in three3 patients. Tract ablation was performed for a mean of 4.8 s (range, 4-6 s). No adverse events occurred during the procedure. Bleeding through the biopsy tract was not apparent on Doppler ultrasound, and abnormal fluid was not detected in the abdominal cavity on CT. Procedure-related complications were not reported on telephone interview. CONCLUSION Biopsy tract ablation with the device is technically feasible. If the device is used appropriately considering its potential advantages, it may help to reduce the risk of complications associated with liver biopsy. Advances in knowledge: It is technically feasible to perform biopsy tract ablation with the radiofrequency ablation device after liver biopsy.
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Affiliation(s)
- Kyoung Doo Song
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Hyunchul Rhim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Min Woo Lee
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Tae Wook Kang
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Sanghyeok Lim
- 2 Department of Radiology, Guri Hospital, Hanyang University College of Medicine , Guri , South Korea
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Yang M, Pepe D, Schlachta CM, Alkhamesi NA. Endoscopic tattoo: the importance and need for standardised guidelines and protocol. J R Soc Med 2017; 110:287-291. [PMID: 28537104 DOI: 10.1177/0141076817712244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Preoperative endoscopic tattoo is becoming more important with the advent of minimally invasive surgery. Current practices are variable and are operator-dependent. There are no evidence-based guidelines to aid endoscopists in clinical practice. Furthermore, there are still a number of issues with endoscopic tattoo including poor intraoperative visualisation, complications from tattooing and inaccurate documentation leading to the need for intraoperative endoscopy, prolonged operative time and reoperation due to lack of oncologic resection. This review aims to collate and summarise evidence for the best practice of endoscopic tattoo for colorectal lesions in order to provide guidance for endoscopists.
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Affiliation(s)
- Mei Yang
- 1 Canadian Surgical Technologies & Advanced Robotics (CSTAR), London Health Sciences Centre and Department of Surgery, Schulich School of Medicine and Dentistry, Western University, Ontario, ON N6A 3K7, Canada
| | - Daniel Pepe
- 2 Department of Family Medicine, Western University, Ontario, ON N6A 3K7, Canada
| | - Christopher M Schlachta
- 1 Canadian Surgical Technologies & Advanced Robotics (CSTAR), London Health Sciences Centre and Department of Surgery, Schulich School of Medicine and Dentistry, Western University, Ontario, ON N6A 3K7, Canada
| | - Nawar A Alkhamesi
- 1 Canadian Surgical Technologies & Advanced Robotics (CSTAR), London Health Sciences Centre and Department of Surgery, Schulich School of Medicine and Dentistry, Western University, Ontario, ON N6A 3K7, Canada
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Ünal E, İdilman İS, Akata D, Özmen MN, Karçaaltıncaba M. Microvascular invasion in hepatocellular carcinoma. Diagn Interv Radiol 2017; 22:125-32. [PMID: 26782155 DOI: 10.5152/dir.2015.15125] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microvascular invasion is a crucial histopathologic prognostic factor for hepatocellular carcinoma. We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule, irregular tumor margin, peritumoral enhancement, multifocal tumor, increased tumor size, and increased glucose metabolism on positron emission tomography-computed tomography. In the presence of typical findings, microvascular invasion may be predicted.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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15
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Terzi E, Salvatore V, Negrini G, Piscaglia F. Ongoing challenges in the diagnosis of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2016; 10:451-63. [PMID: 26603785 DOI: 10.1586/17474124.2016.1124758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2001, the European Association for the Study of the Liver (EASL) endorsed the possibility of achieving a non-invasive diagnosis of Hepatocellular Carcinoma (HCC) for the first time. Since then, various refinements of the criteria and techniques capable of achieving this diagnosis and the role of plasma and tissue oncomarkers have been reported in the literature and have been accepted to different extents in various geographical areas. Such tools can also potentially imply prognostic significance. The present article critically discusses some of the most relevant and debated challenges which have emerged in this field, including the role of contrast-enhanced ultrasound, and of hepatocyte-specific magnetic resonance contrast agents, the pitfall of transient hepatic attenuation differences, the reliability of biopsy and the status of biomarkers.
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Affiliation(s)
- Eleonora Terzi
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Veronica Salvatore
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Giulia Negrini
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Fabio Piscaglia
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
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Attwa MH, El-Etreby SA. Guide for diagnosis and treatment of hepatocellular carcinoma. World J Hepatol 2015; 7:1632-1651. [PMID: 26140083 PMCID: PMC4483545 DOI: 10.4254/wjh.v7.i12.1632] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/31/2014] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is ranked as the 5th common type of cancer worldwide and is considered as the 3rd common reason for cancer-related deaths. HCC often occurs on top of a cirrhotic liver. The prognosis is determined by several factors; tumour extension, alpha-fetoprotein (AFP) concentration, histologic subtype of the tumour, degree of liver dysfunction, and the patient’s performance status. HCC prognosis is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Analysis of recent studies showed that AFP assessment lacks adequate sensitivity and specificity for effective surveillance and diagnosis. Many tumour markers have been tested in clinical trials without progressing to routine use in clinical practice. Thus, surveillance is still based on ultrasound (US) examination every 6 mo. Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography and CT arterial portography in addition to the conventional hepatic angiography. This article provides an overview and spotlight on the different diagnostic modalities and treatment options of HCC.
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Abstract
Accurate tests for at-risk populations are available for hepatitis B virus, hepatitis C virus (HCV), and hepatocellular carcinoma (HCC). Effective treatments for all three diseases exist if diagnosed early. New antivirals are making a significant impact on HCV. Liver transplant is curative for early HCC and is prioritized by the United Network for Organ Sharing in the United States. Screening and surveillance for deadly disease only makes sense if there are identifiable populations at risk for the condition, there are sensitive and specific low-cost tests available for the condition, and there are effective treatments for the condition.
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18
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Abei M, Okumura T, Fukuda K, Hashimoto T, Araki M, Ishige K, Hyodo I, Kanemoto A, Numajiri H, Mizumoto M, Sakae T, Sakurai H, Zenkoh J, Ariungerel G, Sogo Y, Ito A, Ohno T, Tsuboi K. A phase I study on combined therapy with proton-beam radiotherapy and in situ tumor vaccination for locally advanced recurrent hepatocellular carcinoma. Radiat Oncol 2013; 8:239. [PMID: 24131485 PMCID: PMC3854490 DOI: 10.1186/1748-717x-8-239] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/05/2013] [Indexed: 02/08/2023] Open
Abstract
Background Proton-beam radiotherapy (PBT) has been shown to be effective to hepatocellular carcinoma (HCC) as a nonsurgical local treatment option. However, HCC still remains as one of the most difficult cancers to be cured because of frequent recurrences. Thus, methods to inhibit the recurrence need to be explored. To prevent the HCC recurrence, we here report on a prospective phase I study of ‘in situ’ tumor vaccination using CalTUMP, a newly developed immunoadjuvant consisting of BCG extract bound to hydroxyapatite and microparticulated tuberculin, following local PBT for HCC. Methods Patients with locally advanced recurrent HCC, which had been heavily pretreated with various treatments, were enrolled. PBT was performed with the conventional method to the target HCC. Subsequently, CalTUMP was injected into the same irradiated-tumor three times at one-week intervals. Three dose-levels of CalTUMP (1/10, 1/3, and 1/1) were administered to 3 patients each. Vital signs, blood samples, ultrasound, and computed tomographic scans were monitored to evaluate the safety. Results Three intratumoral injections of CalTUMP following PBT (median dose: 72.6 GyE) were accomplished in 9 patients. Transient low-grade fever and minor laboratory changes were observed in 7 patients after CalTUMP injections. No other treatment-related adverse events were observed. Median progression-free survival was 6.0 months (range: 2.1-14.2) and 4 patients were progression-free for more than 1 year. Conclusions Intratumoral injection of CalTUMP following PBT was feasible and safe in patients with heavily pre-treated HCC. Further clinical studies to evaluate the efficacy of this in situ tumor vaccination are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Koji Tsuboi
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305-8575, Japan.
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19
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Lopez KT, Kuwada SK, Wong LL. Consequences of needle tract seeding of hepatocellular cancer after liver transplant. Clin Transplant 2013; 27:E400-6. [PMID: 23837571 DOI: 10.1111/ctr.12160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 12/12/2022]
Abstract
Although liver biopsy is a relatively safe procedure, needle tract seeding (NTS) of hepatocellular carcinoma (HCC) is described in up to 5% of patients after liver biopsy. The rate of NTS in patients with HCC who had liver transplantation is unknown. We performed a retrospective analysis of 759 HCC cases from August 1992 to August 2011. Demographics, ethnicities, risk factors, tumor characteristics, treatments, recurrence, and survival were collected. Patients who underwent percutaneous liver biopsy, resection, and transplant were identified. In all, 359 underwent biopsy to diagnose HCC and 42 patients underwent liver transplant. None of 171 patients who underwent radiofrequency ablation alone had seeding. None of the 11 patients who had biopsy and radiofrequency ablation performed in a single session developed NTS; however, two of 12 patients who had biopsy and radiofrequency ablation performed at separate sessions had NTS. Two patients underwent liver transplantation and subsequently developed needle tract seeding eventually died from HCC. Although the incidence of needle tract seeding was low in liver transplant patients, it can potentially change a curative therapy into a non-curative one. Single-session liver biopsy and radiofrequency ablation may reduce the risk of needle tract seeding of HCC.
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Affiliation(s)
- Kristi T Lopez
- Department of Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
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20
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Young RS, Aldiwani M, Hakeem AR, Nair A, Guthrie A, Wyatt J, Treanor D, Morris-Stiff G, Jones RL, Prasad KR. Pre-liver transplant biopsy in hepatocellular carcinoma: a potential criterion for exclusion from transplantation? HPB (Oxford) 2013; 15:418-27. [PMID: 23458127 PMCID: PMC3664045 DOI: 10.1111/hpb.12008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND In cirrhotic patients with hepatocellular carcinoma (HCC), poor differentiation in pre-liver transplantation (LT) biopsy of the largest tumour is used as a criterion for exclusion from LT in some centres. The potential role of pre-LT biopsy at one centre was explored. METHODS A prospective database of patients undergoing orthotopic LT for radiologically diagnosed HCC at St James's University Hospital, Leeds during 2006-2011 was analysed. RESULTS A total of 60 predominantly male (85.0%) patients with viral hepatitis were identified. There were discrepancies between radiological and histopathological findings with respect to the number of tumours identified (in 27 patients, 45.0%) and their size (in 63 tumours, 64.3%). In four (6.7%) patients, the largest lesion, which would theoretically have been targeted for biopsy, was not the largest in the explant. Nine (31.0%) patients with multifocal HCC had tumours of differing grades. In two (6.9%) patients, the largest tumour was well differentiated, but smaller tumours in the explant were poorly differentiated. In one patient, the largest lesion was benign and smaller invasive tumours were confirmed histologically. CONCLUSIONS The need to optimize selection for LT in HCC remains. In the present series, the largest tumour was not always representative of overall tumour burden or biological aggression and its potential use to exclude patients from LT is questionable.
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Affiliation(s)
- Richard S Young
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Mohammed Aldiwani
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Abdul R Hakeem
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Amit Nair
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Ashley Guthrie
- Department of Radiology, St James's University HospitalLeeds, UK
| | - Judy Wyatt
- Department of Histology, St James's University HospitalLeeds, UK
| | - Darren Treanor
- Department of Histology, St James's University HospitalLeeds, UK
| | - Gareth Morris-Stiff
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Rebecca L Jones
- Department of Hepatology, St James's University HospitalLeeds, UK
| | - K Rajendra Prasad
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK,Correspondence K. Rajendra Prasad, Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Tel: + 44 113 206 5921. Fax: + 44 113 244 8182. E-mail:
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Needle tract implantation of hepatoblastoma after percutaneous needle biopsy: report of a case. Surg Today 2013; 44:1138-41. [PMID: 23605217 DOI: 10.1007/s00595-013-0579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 11/04/2012] [Indexed: 02/07/2023]
Abstract
A 13-year-old boy was referred to us for investigation of a giant liver mass, approximately 16 cm in diameter. Sonographically guided percutaneous needle biopsy was performed and histological examination revealed a fetal-type hepatoblastoma. After four courses of chemotherapy, we performed a left hepatic trisegmentectomy. Follow-up computed tomography, 55 months after the surgery, showed a 1-cm tumor on the route of the preoperative needle biopsy. A second laparotomy revealed a peritonealised tumor, which was excised. The histology of this tumor was identical to that of the primary hepatoblastoma. To our knowledge, this is only the second report of needle tract implantation of hepatoblastoma after percutaneous needle biopsy.
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Mueller M, Mason RA, Kratzer W, Oeztuerk S, Haenle MM. Sonographically guided puncture of the pancreas: incidence of complications, and risk factors. J Med Ultrason (2001) 2013; 40:19-26. [PMID: 27276920 DOI: 10.1007/s10396-012-0376-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/12/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE Data yielded by transabdominal ultrasound-guided puncture techniques are valuable for determining the malignancy of inoperable mass lesions of the pancreas. In this study we analyzed the incidence of complications and the risk factors. METHODS A total of 430 punctures of the pancreas were performed for 281 patients. Risk factors were prospectively assessed and complications were recorded. All punctures were sonographically guided. RESULTS The 281 patients underwent a total of 351 puncture procedures including 430 punctures and 901 passes. The maximum diameter of the pancreatic mass lesion was documented; the mean diameter was 48.3 ± 29.1 mm. 75.8 % of punctures were performed with a needle diameter of 0.7-0.95 mm, and 23.0 % of punctures were performed as cutting biopsies producing a tissue sample 1.2 or 1.6 mm in diameter. In 77.8 % of punctures, one puncture was performed, and in 21.9 %, two punctures were performed. Three punctures were performed for one patient (0.3 %) only. The incidence of major complications was 0.3 %. None of the assessed risk factors was associated with an elevated incidence of complications. CONCLUSION Our findings demonstrate the safety of transabdominal percutaneous puncture of the pancreas but do not enable conclusions to be drawn with regard to individual risk factors.
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Affiliation(s)
- Michael Mueller
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Richard Andrew Mason
- Brecksville Division, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10000 Brecksville Road, Brecksville, OH, 44141, USA
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Suemeyra Oeztuerk
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mark Martin Haenle
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Jain N, Goyal N, Mukherjee K, Kamath S. Ultrasound of the abdominal wall: What lies beneath? Clin Radiol 2013; 68:85-93. [DOI: 10.1016/j.crad.2012.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 05/24/2012] [Accepted: 05/28/2012] [Indexed: 12/30/2022]
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Wang CP, Wang H, Qu JH, Lu YY, Bai WL, Dong Z, Gao XD, Rong GH, Zeng Z, Yang YP. Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma. World J Gastroenterol 2012; 18:6587-96. [PMID: 23236233 PMCID: PMC3516217 DOI: 10.3748/wjg.v18.i45.6587] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/30/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the rate and risk factors for tumour seeding in a large cohort of patients.
METHODS: Over an 8-year period, 1436 hepatocellular carcinoma (HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography (CT)]. Follow-up CT or magnetic resonance imaging was performed every 3 mo. The detailed clinical data were recorded to analyse the risk factors for seeding.
RESULTS: The median follow-up time was 18 (range 1-90) mo. Seeding was detected in 11 patients (0.76%) at 1-24 (median 6.0) mo after cryoablation. Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient. Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs. Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding. Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding (P = 0.017; odds ratio 2.57; 95%CI: 1.47-3.65). Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo; P = 0.042; 95%CI: (-19.115)-(-0.468)].
CONCLUSION: The risk of seeding after cryoablation for HCC is small. Direct puncture of subcapsular tumours should be avoided to minimise seeding.
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Ahn DW, Shim JH, Yoon JH, Kim CY, Lee HS, Kim YT, Kim YJ. Treatment and clinical outcome of needle-track seeding from hepatocellular carcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:106-12. [PMID: 21757981 PMCID: PMC3304641 DOI: 10.3350/kjhep.2011.17.2.106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background/Aims Needle-track seeding is a rare but important complication of diagnostic and therapeutic ultrasound (US)-guided procedures in hepatocellular carcinoma (HCC). We examined the frequency of needle-track seeding after US-guided percutaneous ethanol injection (PEI), fine-needle aspiration biopsy (FNAB), and percutaneous transhepatic biliary drainage (PTBD) in order to determine the appropriate treatment for needle-track seeding and its clinical outcome. Methods We analyzed the clinical characteristics and treatment outcomes in eight patients who experienced needle-track seeding from HCC after an US-guided procedure (FNAB, PEI, or PTBD) between January 1990 and July 2004. Results Seven (0.14%) of 5,092 patients who experienced needle-track seeding (2 after PEI, 4 after FNAB, and 1 after PTBD) during the study period and 1 other patient who experienced needle-track seeding recently were recruited for this study. Two of the eight patients underwent mass excision and the other six patients underwent en-bloc wide excision for the needle-track seeding. Tumors recurred in the needle-tracks in both patients who underwent mass excision but not in the six patients who underwent en-bloc wide excision. Mortality occurred in three patients who experienced the recurrence and progression of intrahepatic HCC. Conclusions The incidence of needle-track seeding after US-guided procedures in HCC was 0.14%. En-bloc wide excision seems to be the optimal treatment for minimizing the probability of tumor recurrence due to needle-track seeding.
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Affiliation(s)
- Dong-Won Ahn
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Becker-Weidman DJS, Kalb B, Sharma P, Kitajima HD, Lurie CR, Chen Z, Spivey JR, Knechtle SJ, Hanish SI, Adsay NV, Farris AB, Martin DR. Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements. Radiology 2011; 261:824-33. [PMID: 21969663 DOI: 10.1148/radiol.11110157] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To measure diagnostic performance in the detection of hepatocellular carcinoma (HCC) by using the most recent technology and multiphase gadolinium-enhanced magnetic resonance (MR) imaging and to compare with earlier results at the same institution. MATERIALS AND METHODS This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was obtained. Between January 2008 and April 2010, 101 patients underwent liver transplantation and pretransplantation abdominal MR imaging within 90 days. Prospective image interpretations from the clinical record were reviewed for documentation of HCC, including size, number, and location. Liver explant histologic examination provided the reference standard for lesion analysis and was performed in axial gross slices in conjunction with the MR imaging report for direct comparison. Tumors were categorized according to size (≥ 2 cm or <2 cm), and MR imaging detection sensitivity, specificity, predictive values, and accuracy were calculated according to category. The Fisher exact test was used to compare results from this study against prior reported results. RESULTS Thirty-five (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specificity of 97.1% (34 of 35) and 100% (66 of 66), respectively. For lesions 2 cm or larger, MR imaging had a sensitivity and specificity of 100% (23 of 23) and 100% (78 of 78), respectively. For lesions smaller than 2 cm, MR imaging had a sensitivity and specificity of 82.6% (19 of 23) and 100% (78 of 78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53 of 58) in the current study, compared with 77.8% in 2007 (P = .07). For lesions smaller than 2 cm, the sensitivity was 87.5% (28 of 32) in the current study, compared with 55.6% previously (P = .02). CONCLUSION MR imaging remains a highly accurate diagnostic method for the preoperative evaluation of HCC, and detection of small (<2 cm) tumors has been significantly improved compared with that of earlier studies.
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Müllhaupt B, Durand F, Roskams T, Dutkowski P, Heim M. Is tumor biopsy necessary? Liver Transpl 2011; 17 Suppl 2:S14-25. [PMID: 21744470 DOI: 10.1002/lt.22374] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center, Division of Gastroenterology and Hepatology, Zurich, Switzerland.
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A biopsy tool with integrated piezoceramic elements for needle tract cauterization and cauterization monitoring. Biomed Microdevices 2011; 14:55-65. [PMID: 21898007 DOI: 10.1007/s10544-011-9585-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper reports the feasibility of biopsy needle tract cauterization and cauterization monitoring using an embedded array of piezoceramic microheaters. Circular heaters of lead zirconate titanate (PZT-5A), with 200 μm diameter and 70-80 μm thickness, are fabricated using a batch mode micro ultrasonic machining process. These are then assembled into cavities in the walls of 20-gauge stainless steel needles and sealed with epoxy. Experiments are performed by inserting the proposed biopsy needle into porcine tissue samples. The needle surface exceeds the minimum target temperature rise of 33°C for either radial or thickness mode vibrations. The corresponding input power levels are 236 mW and 325 mW, respectively. The tissue cauterization extends 1-1.25 mm beyond the perimeter of the needle and is uniform in all directions. After cauterization, the fundamental anti-resonance frequency and the corresponding impedance magnitude of the PZT heater decrease by 4.1% and 42.6%, respectively, thereby providing a method to monitor the extent of tissue cauterization. A sensing interface circuit capable of measuring the resonance frequency shift of the PZT elements is built and tested using discrete integrated circuit components. The circuit detects the resonance frequency shift from 8.22 MHz to 7.96 MHz of the PZT elements when the biopsy needle is inserted into wax medium. An interface circuit for actuation of the PZT elements for tissue cauterization is also described.
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Kim YS. Percutaneous interventional procedures in an era of liver transplantation. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:96-8. [PMID: 21757979 PMCID: PMC3304643 DOI: 10.3350/kjhep.2011.17.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Microvascular invasion in hepatocellular carcinoma: is it predictable with pretransplant MRI? AJR Am J Roentgenol 2011; 196:1083-9. [PMID: 21512074 DOI: 10.2214/ajr.10.4720] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to correlate clinicopathologic and MRI parameters with the presence of microvascular invasion at histopathologic examination in patients with hepatocellular carcinoma (HCC) who are undergoing liver transplantation. MATERIALS AND METHODS In this retrospective single-center study, we assessed 60 patients (47 men and 13 women; mean age, 58 years) with HCC who underwent liver transplantation and pretransplant MRI (performed within 90 days before liver transplantation). Two observers analyzed the following tumor parameters in consensus: number, size, T1 and T2 signal intensity, margins, presence of capsule or pseudocapsule, distance to closest vessel, distance to liver capsule, and quantitative tumor enhancement. The size and number of HCCs, tumor differentiation, and the presence or absence of microvascular invasion were determined at histopathologic examination. Odds ratios (ORs) were calculated and logistic regression analysis was performed to assess the utility of these clinicopathologic and imaging parameters for predicting microvascular invasion. RESULTS None of the clinical parameters or morphologic and enhancement MRI features of HCC was predictive of microvascular invasion. Tumor multifocality, on both MRI and pathologic examination, was the only variable that predicted microvascular invasion (OR = 2.43 and p = 0.013 for MRI; OR = 1.94 and p = 0.013 for pathologic examination). The presence of three or more tumors on MRI and four or more tumors at pathologic examination had high specificity (88.2% and 91.2%, respectively) for the prediction of microvascular invasion. CONCLUSION Tumor multifocality on MRI was the only parameter that correlated significantly with microvascular invasion. All other MRI tumor characteristics failed to predict microvascular invasion.
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Xu JF, Liu HY, Shi Y, Wei ZH, Wu Y. Evaluation of hepatocellular carcinoma by contrast-enhanced sonography: correlation with pathologic differentiation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:625-633. [PMID: 21527610 DOI: 10.7863/jum.2011.30.5.625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether contrast-enhanced sonography can be used to differentiate histopathologic grades of hepatocellular carcinoma. METHODS This study included 54 patients with hepatocellular carcinomas. All patients underwent fundamental and contrast-enhanced sonographic examinations. Auto-tracking contrast quantification software was used to determine the contrast arrival time, time to peak, peak intensity, contrast-enhanced time, wash-out time, enhancement slope, and clearance slope of the lesions. All lesions were confirmed by surgery. The hepatocellular carcinoma lesions were divided into 2 groups according to the World Health Organization grading system: group 1 (well-differentiated hepatocellular carcinomas) and group 2 (moderately to poorly differentiated carcinomas). The enhancement parameters between the groups were compared using a Student t test. RESULTS Fourteen of 20 well-differentiated lesions showed a "fast-in, slow-out" enhancement pattern, whereas 6 showed a "fast-in, fast-out" pattern. Thirty-three of 34 moderately to poorly differentiated lesions showed a fast-in, fast-out pattern, whereas only 1 showed a fast-in, slow-out pattern. The differences in the time to peak, contrast-enhanced time, wash-out time, enhancement slope, and clearance slope between the groups were statistically significant (P < .05), whereas the differences in the arrival time and peak intensity were not significant (P > .05). CONCLUSIONS The contrast patterns of well-differentiated and moderately to poorly differentiated hepatocellular carcinomas were quite different on contrast-enhanced sonography. The time to peak, contrast-enhanced time, and wash-out time of the well-differentiated hepatocellular carcinomas were longer than those of the moderately to poorly differentiated carcinomas, whereas the enhancement slope and clearance slope of the well-differentiated lesions were lower those that of the moderately to poorly differentiated lesions.
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Affiliation(s)
- Jin Feng Xu
- Department of Ultrasonography, Second Clinical College of Jinan University, Shenzhen People's Hospital, 518020 Shenzhen, China.
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Cucchetti A, Piscaglia F, Grigioni AD, Ravaioli M, Cescon M, Zanello M, Grazi GL, Golfieri R, Grigioni WF, Pinna AD. Preoperative prediction of hepatocellular carcinoma tumour grade and micro-vascular invasion by means of artificial neural network: a pilot study. J Hepatol 2010; 52:880-8. [PMID: 20409605 DOI: 10.1016/j.jhep.2009.12.037] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 11/06/2009] [Accepted: 12/12/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) prognosis strongly depends upon nuclear grade and the presence of microscopic vascular invasion (MVI). The aim of this study was to develop an artificial neural network (ANN) that is able to predict tumour grade and MVI on the basis of non-invasive variables. METHODS Clinical, radiological, and histological data from 250 cirrhotic patients resected (n=200) or transplanted (n=50) for HCC were analyzed. ANN and logistic regression models were built on a training group of 175 randomly chosen patients and tested on the remaining testing group of 75. Receiver operating characteristics curve (ROC) and k-statistics were used to analyze model accuracy in the prediction of the final histological assessment of tumour grade (G1-G2 vs. G3-G4) and MVI (absent vs. present). RESULTS Pathologic examination showed G3-G4 in 69.6% of cases and MVI in 74.4%. Preoperative serum alpha-fetoprotein (AFP), tumour number, size, and volume were related to tumour grade and MVI (p<0.05) and were used for ANN building, whereas, tumour number did not enter into the logistic models. In the training group, ANN area under ROC curves (AUC) for tumour grade and MVI prediction were 0.94 and 0.92, both higher (p<0.001) than those of logistic models (0.85 for both). In the testing group, ANN correctly identified 93.3% of tumour grades (k=0.81) and 91% of MVI (k=0.73). Logistic models correctly identified 81% of tumour grades (k=0.55) and 85% of MVI (k=0.57). CONCLUSION ANN identifies HCC tumour grades and MVI on the basis of preoperative variables more accurately than the conventional linear model and should be used for tailoring clinical management.
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Affiliation(s)
- Alessandro Cucchetti
- Liver and Multiorgan Transplant Unit, Policlinico S.Orsola-Malpighi, University of Bologna, Italy.
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Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol 2010; 21:969-75. [PMID: 20304676 DOI: 10.1016/j.jvir.2010.01.011] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sanjay Gupta
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Unit 325, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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A trucut biopsy needle for bipolar radiofrequency ablation of needle tract: a proof-of-concept experiment. Eur Radiol 2010; 20:2000-4. [PMID: 20179938 DOI: 10.1007/s00330-010-1739-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 01/08/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop a trucut biopsy needle featuring two electrodes that allow for bipolar radiofrequency (RF) coagulation of the puncture tract. METHODS We modified a 14-G trucut biopsy needle to contain two insulated electrodes and connected the device to an RF generator. Biopsies in ex vivo porcine liver and kidney were performed. The puncture tract was coagulated by using different RF energy settings (5 W, 10 W, 20 W). Tissue specimens were dissected along the puncture tract and the coagulation area was macroscopically evaluated. CT-guided in vivo liver and kidney biopsies were performed in two domestic pigs. Lengths of specimens were measured. Post-biopsy contrast-enhanced CT examinations were performed to rule out biopsy-related bleeding. Animals were euthanised and coagulation areas macroscopically explored. RESULTS The mean diameters of the coagulated area around the ex vivo biopsy tract were 4.2 +/- 1.1 mm (5 W), 6.0 +/- 2.0 mm (10 W) and 5.2 +/- 0.51 mm (20 W) in liver and 5.0 +/- 0.7 mm (5 W), 6.6 +/- 0.9 (10 W) and 6.0 +/- 2.0 mm (20 W) in kidney. After biopsies CT revealed no bleeding. Mean maximum coagulation diameters were 10.1 +/- 4.6 mm (10 W) in liver and 6.0 +/- 2.5 mm (10 W) in kidney. Mean length of the specimens was 12.2 +/- 4.4 mm in kidney and 11.1 +/- 3.6 mm in liver tissue. CONCLUSION Bipolar RF biopsy is a promising tool for tract coagulation after percutaneous biopsy.
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Clifford MA, Banovac F, Levy E, Cleary K. Assessment of Hepatic Motion Secondary to Respiration for Computer Assisted Interventions. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080209146038] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cresswell AB, Welsh FKS, Rees M. A diagnostic paradigm for resectable liver lesions: to biopsy or not to biopsy? HPB (Oxford) 2009; 11:533-40. [PMID: 20495704 PMCID: PMC2785947 DOI: 10.1111/j.1477-2574.2009.00081.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 04/05/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite a growing body of evidence reporting the deleterious mechanical and oncological complications of biopsy of hepatic malignancy, a small but significant number of patients undergo the procedure prior to specialist surgical referral. Biopsy has been shown to result in poorer longterm survival following resection and advances in modern imaging modalities provide equivalent, or better, diagnostic accuracy. METHODS The literature relating to needle-tract seeding of primary and secondary liver cancers was reviewed. MEDLINE, EMBASE and the Cochrane Library were searched for case reports and series relating to the oncological complications of biopsy of liver malignancies. Current non-invasive diagnostic modalities are reviewed and their diagnostic accuracy presented. RESULTS Biopsy of malignant liver lesions has been shown to result in poorer longterm survival following resection and does not confer any diagnostic advantage over a combination of non-invasive imaging techniques and serum tumour markers. CONCLUSIONS Given that chemotherapeutic advances now often permit downstaging and subsequent resection of 'unresectable' disease, the time has come to abandon biopsy of solid lesions outside the setting of a specialist multi-disciplinary team meeting (MDT).
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Affiliation(s)
- Adrian B Cresswell
- Basingstoke Hepatobiliary Unit, Basingstoke and North Hampshire Hospitals NHS Foundation Trust Basingstoke, UK
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Trillaud H, Bruel JM, Valette PJ, Vilgrain V, Schmutz G, Oyen R, Jakubowski W, Danes J, Valek V, Greis C. Characterization of focal liver lesions with SonoVue®-enhanced sonography: International multicenter-study in comparison to CT and MRI. World J Gastroenterol 2009; 15:3748-56. [PMID: 19673015 PMCID: PMC2726452 DOI: 10.3748/wjg.15.3748] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue®-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI).
METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrast-enhanced US (n = 134), contrast-enhanced CT (n = 115) and/or dynamic contrast-enhanced MRI (n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology (n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.
RESULTS: In comparison with unenhanced US, SonoVue® markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue®-enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.
CONCLUSION: SonoVue®-enhanced sonography emerges as the most sensitive, most specific and thus most accurate imaging modality for the characterization of focal liver lesions.
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Fowler N, Asatiani E, Cheson B. Needle tract seeding after bone marrow biopsy in non-Hodgkin lymphoma. Leuk Lymphoma 2009; 49:156-8. [DOI: 10.1080/10428190701732846] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ng KM, Yan TD, Black D, Chu FCK, Morris DL. Prognostic determinants for survival after resection/ablation of a large hepatocellular carcinoma. HPB (Oxford) 2009; 11:311-20. [PMID: 19718358 PMCID: PMC2727084 DOI: 10.1111/j.1477-2574.2009.00044.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 01/17/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection of large hepatocellular carcinomas (HCC), measuring at least 10 cm remains a controversial debate. Multiple studies on HCCs treated with surgical resection and/or ablation had shown variable results with 5-year survival rates ranging from 0% to 54.0%. The aim of this study was to evaluate the survival of patients with HCCs measuring at least 10 cm and to identify the potential prognostic variables affecting the outcome. METHODS Retrospective analysis was performed on the prospectively updated HCC database. A total of 44 patients with tumours measuring 10 cm or more were 'curatively' treated with surgical resection with or without ablation. Patient demographics, clinical, surgical, pathology and survival data were collected and analysed. RESULTS Thirty-one patients received surgical resection alone. Thirteen other patients were treated with a combination of surgical resection and ablation. The median follow-up duration was 14.5 months. The overall median survival at 1, 3 and 5 years were 66.4%, 38.1% and 27.8%, respectively. The median time to tumour recurrence was 10.7 months and the 1, 3 and 5-year disease-free survival were 49.6%, 23.9% and 19.1%, respectively. Univariate analysis demonstrated cirrhosis, microvascular invasion, poor tumour differentiation and ethnicity to adversely affect survival. For overall survival, only cirrhosis, poor tumour differentiation and ethnicity were significant on multivariate analysis. Portal vein tumour thrombus, microvascular invasion and ethnicity were identified on univariate analysis to significantly affect disease-free survival. CONCLUSION Surgical treatment offers good survival to patients with large HCCs (> or = 10 cm). Both cirrhosis and poor tumour differentiation are independent variables prognostic of adverse survival.
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Affiliation(s)
- Keh M Ng
- Department of Surgery, University of New South Wales, St George HospitalSydney, NSW, Australia
| | - Tristan D Yan
- Department of Surgery, University of New South Wales, St George HospitalSydney, NSW, Australia
| | - Deborah Black
- School of Public Health and Community Medicine, University of New South WalesSydney, NSW, Australia
| | - Francis C K Chu
- Department of Surgery, University of New South Wales, St George HospitalSydney, NSW, Australia
| | - David L Morris
- Department of Surgery, University of New South Wales, St George HospitalSydney, NSW, Australia
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Chang S, Kim SH, Lim HK, Kim SH, Lee WJ, Choi D, Kim YS, Rhim H. Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas: lessons learned from a 10-year experience. Korean J Radiol 2008; 9:268-74. [PMID: 18525230 PMCID: PMC2627263 DOI: 10.3348/kjr.2008.9.3.268] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.
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Affiliation(s)
- Samuel Chang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
BACKGROUND Progress in liver imaging has made pretransplantation tumor biopsy no longer systematic in patients with hepatocellular carcinoma (HCC). OBJECTIVES Our aim was to evaluate the accuracy of a preoperative diagnosis of HCC based on clinical and radiological findings in 102 cirrhotics qualified for liver transplantation (LT) between January 1995 and August 2003 at our institution. METHODS The diagnostic accuracy of our policy was assessed by comparing pretransplant diagnosis with the pathologic report of explanted livers. RESULTS Sensitivity, specificity, positive, and negative predictive values for the preoperative clinical and radiological diagnosis of HCC were 89%, 94.3%, 77%, and 93.3%, respectively. A false-positive preoperative diagnosis was made in 20 of 102 patients (19.6%) (dysplastic nodules [n=9], regenerative nodules [n=5] cholangiocellular carcinoma [n=1], hemangioma [n=1], and no lesion [n=4]). All tumors larger than 3 cm were correctly diagnosed, irrespective of serum alpha-fetoprotein (sAFP) levels. The risk of overestimating the diagnosis of HCC in the subgroup of patients with tumors less than 3 cm was conversely correlated with preliver transplantation sAFP (sAFP<or=100 ng/L: 28%; sAFP>100: 11%; sAFP>200: 0%). CONCLUSION In cirrhotics with nodules larger than 3 cm irrespective of sAFP or nodules less than 3 cm with sAFP greater than 200 ng/L, the pretransplant diagnosis of HCC can be made without performing biopsy. In other cases (i.e., nodules less than 3 cm and sAFP lower than 200 ng/L), histologic confirmation of HCC or a close follow-up imaging should be considered.
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Sugimoto K, Moriyasu F, Kamiyama N, Metoki R, Yamada M, Imai Y, Iijima H. Analysis of morphological vascular changes of hepatocellular carcinoma by microflow imaging using contrast-enhanced sonography. Hepatol Res 2008; 38:790-9. [PMID: 18507694 DOI: 10.1111/j.1872-034x.2008.00331.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To determine whether the findings of microflow imaging (MFI), composed of a flash replenishment and a maximum intensity holding sequence, using contrast-enhanced sonography, correlate with the degree of histological differentiation of hepatocellular carcinoma (HCC). METHODS This study was approved by the institutional review board; patients gave informed consent. The samples comprised of 61 nodules histologically diagnosed as HCC: 20 well-differentiated, 26 moderately-differentiated, and 15 poorly-differentiated HCC. SonoVue was used as the ultrasound (US) contrast agent. The US equipment used was a SSA-770 A with the imaging mode set at MFI. MFI is an imaging method combining flash replenishment imaging and maximum intensity holding. Two independent readers (readers 1 and 2) classified the microflow images into four patterns: (i) normal pattern; (ii) cotton pattern; (iii) vascular pattern; and (iv) dead wood pattern. The results were compared with the degree of histopathological differentiation of the HCC. RESULTS In each of the 61 HCC, blood vessels in the tumor were clearly resolved down to their fine branches. With regard to the relationship between imaging patterns and thehistological findings, it was found (with high percentages) that the normal and cotton patterns were associated with well-differentiated HCC, that the vascular pattern was associated with moderately-differentiated HCC, and that the dead wood pattern was associated with poorly-differentiated HCC. If HCC with the normal and cotton patterns were assessed as well differentiated and those with the vascular or dead wood pattern were assessed as moderately or poorly differentiated, the sensitivity, specificity, and accuracy of these assessments were found to be 85%, 92.7%, and 90%, respectively, for reader 1, and 85%, 82.9%, and 83.6%, respectively, for reader 2. CONCLUSION The angioarchitecture and hemodynamics of HCC could be evaluated in detail using MFI. The results of this study demonstrate the feasibility of a non-invasive preoperative diagnosis of the histological differentiation of HCC using MFI.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology & Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Latteri F, Sandonato L, Di Marco V, Parisi P, Cabibbo G, Lombardo G, Galia M, Midiri M, Latteri MA, Craxì A. Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: a prospective study. Dig Liver Dis 2008; 40:684-9. [PMID: 18294940 DOI: 10.1016/j.dld.2007.12.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 12/19/2007] [Accepted: 12/20/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neoplastic seeding of hepatocellular carcinoma may arise after radiofrequency ablation. AIMS In order to clarify the real risk of seeding, we observed a prospective cohort of patients undergoing radiofrequency ablation. METHODS Ninety-three (22.9%) out of 406 consecutive patients with hepatocellular carcinoma superimposed to cirrhosis diagnosed at our Liver Unit (2000-2005) were selected for radiofrequency ablation according to the Barcelona 2000 EASL guidelines. Seventy-one patients were treated by a percutaneous approach and 22 at laparotomy. After radiofrequency ablation ultrasound scan was repeated every 3 months and spiral-computed tomography every 6 months. RESULTS Overall 145 sessions were performed in 93 patients: 113 (77.9%) by a percutaneous approach and 32 (22.1%) at laparotomy. The median follow-up was 23 months (range 1-60). Only 1 of the 71 patients (1.4%; 95% C.I. 0.25-7.56) treated percutaneously and none of the 22 (0%; 95% C.I. 0-14.8) treated at laparotomy showed neoplastic seeding. CONCLUSION In our experience the risk of seeding of hepatocellular carcinoma after radiofrequency ablation was small (1.1% per patient, 95% C.I. 0.19-5.84; 0.7% per procedure, 95% C.I. 0.12-3.80). A stringent selection of patients for radiofrequency ablation and retraction of the needle with a hot tip may have been instrumental in obtaining this low frequency.
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Affiliation(s)
- F Latteri
- Department of Gastroenterology and Hepatology, University of Palermo, Italy.
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Hammill CW, Wong LL. Intrahepatic cholangiocarcinoma: a malignancy of increasing importance. J Am Coll Surg 2008; 207:594-603. [PMID: 18926465 DOI: 10.1016/j.jamcollsurg.2008.04.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/14/2008] [Accepted: 04/22/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Chet W Hammill
- Departments of Surgery, University of Hawaii John A Burns School of Medicine, and Hawaii Medical Center-East, Honolulu, HI 96817, USA
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Sugimoto K, Moriyasu F, Kamiyama N, Yamada M, Iijima H. Correlation between parametric imaging using contrast ultrasound and the histological differentiation of hepatocellular carcinoma. Hepatol Res 2008; 38:273-80. [PMID: 17825060 DOI: 10.1111/j.1872-034x.2007.00259.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To determine whether parametric imaging correlates with the degree of histological differentiation of hepatocellular carcinoma (HCC). METHODS The samples comprised 49 nodules diagnosed histologically as HCC: 19 well differentiated (w-HCC), 22 moderately differentiated (m-HCC), and eight poorly differentiated (p-HCC). The ultrasound (US) equipment used was SSA-770 A (Toshiba Medical Systems, Otawara, Japan) and the contrast agent was SonoVue (Bracco, Milan, Italy). After 1.5 mL of SonoVue was injected intravenously and staining of the tumors and parenchyma was confirmed, microbubbles in the scanned volume were eliminated using high mechanical index (MI) scanning frames. The "arrival time (T(A)) images," reflecting beta-values, were displayed with color codes at the phase after reperfusion. Images at the phase when the staining reached a plateau (90-180 s) were used as "A images," reflecting A values. These images were compared between each histological grade of differentiation. RESULTS Analysis of T(A) images indicated that beta-values in m-HCC were higher than those in the adjacent non-tumor parenchyma in all 22 samples and also were significantly higher than in the other HCCs (P < 0.001 for w-HCC; P < 0.05 for p-HCC). Furthermore, beta-values in p-HCC samples had significantly larger variations in terms of time and space than in the other HCCs (P < 0.001 for w-HCC; P < 0.01 for m-HCC). Analysis of A images indicated that the A value for w-HCC was significantly higher than those for either m-HCC or p-HCC (P < 0.001). CONCLUSION Both T(A) and A images were useful for diagnosing the histological differentiation of HCC.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Rowe LR, Mulvihill SJ, Emerson L, Gopez EV. Subcutaneous tumor seeding following needle core biopsy of hepatocellular carcinoma. Diagn Cytopathol 2008; 35:717-21. [PMID: 17924404 DOI: 10.1002/dc.20717] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic tumor and one of the most common cancers worldwide. At present, there are two widely used and accepted methods for obtaining diagnostic material for establishing the likelihood of malignancy in a hepatic mass, namely fine-needle aspiration (FNA) cytology and needle core biopsy (NCB). In recent years, however, tumor cell seeding along the needle tract has been shown to be a risk associated with using these procedures to obtain a pathologic diagnosis. We report a case of a patient who presented with a nodule in the anterior abdominal wall at the expected location of the previous NCB tract. FNA biopsy of the abdominal wall lesion confirmed the presence of malignant cells consistent with HCC. The finding of tumor seeding within a NCB tract raises the question of the role of NCB in the diagnostic workup of focal liver lesions.
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Affiliation(s)
- Leslie R Rowe
- Institute for Clinical and Experimental Pathology, Associated Regional and University Pathologists Laboratories, Salt Lake City, Utah, USA
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48
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Bremner KE, Bayoumi AM, Sherman M, Krahn MD. Management of solitary 1 cm to 2 cm liver nodules in patients with compensated cirrhosis: a decision analysis. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:491-500. [PMID: 17703248 PMCID: PMC2657973 DOI: 10.1155/2007/182383] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Current guidelines, based on expert opinion, recommend that suspected 1 cm to 2 cm hepatocellular carcinoma (HCC) detected on screening be biopsied and, if positive, treated (eg, resection or transplantation). Alternative strategies are immediate treatment or observation until disease progression occurs. METHODS A Markov decision model was developed that compared three management strategies - immediate resection, biopsy and resection if positive, and ultrasound surveillance every three months until disease progression - for a single 1 cm to 2 cm liver nodule suspicious for HCC following ultrasound screening and computed tomography confirmation. The cohort included 55-year-old patients with compensated cirrhosis and no significant comorbidities. The model used in the present study incorporated the probabilities of false-positive and false-negative results, needle-track seeding, HCC recurrence, cirrhosis progression and death. The quality-adjusted life expectancy (LE) and the unadjusted LE were evaluated and the model's strength was assessed with sensitivity analyses. RESULTS In the base case analysis, biopsy, resection and surveillance yielded an unadjusted LE of 60.5, 59.7 and 56.6 months, respectively, and a quality-adjusted LE of 46.6, 45.6 and 43.8 months, respectively. In probabilistic sensitivity analyses, biopsy was the preferred strategy 69.5% of the time, resection 30.5% of the time and surveillance never. Resection was the optimal decision if the sensitivity of biopsy was very low (less than 0.45) or if the accuracy of the imaging tests resulted in a high percentage of HCC-positive patients (greater than 76%) in the screened cohort, as with expert interpretation of triphasic computed tomography. CONCLUSIONS The present model suggests that biopsy is the preferred management strategy for these patients. When postimaging probability of HCC is high or pathology expertise is lacking, resection is the best alternative. Surveillance is never the optimal strategy.
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Affiliation(s)
- Karen E Bremner
- Toronto General Research Institute, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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49
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Durand F, Belghiti J, Paradis V. Liver transplantation for hepatocellular carcinoma: role of biopsy. Liver Transpl 2007; 13:S17-23. [PMID: 17969095 DOI: 10.1002/lt.21326] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with compensated cirrhosis (and low Model for End-Stage Liver Disease score) should not undergo transplantation unless they have small hepatocellular carcinoma (HCC). Therefore, presence of HCC should be definitely ascertained before deciding on transplantation in this group of patients. Current imaging techniques allow detection of small liver nodules (<1 cm). Not all liver nodules between 1 and 2 cm are HCC. In addition, benign regenerative nodules have a relatively low potential for degeneration. It is generally agreed that in patients with evidence of cirrhosis, a definitive diagnosis of HCC can be made without tissue analysis in case of nodules >2 cm with a characteristic pattern on either computed tomography (CT) or magnetic resonance imaging (MRI) (hypervascularity in the arterial phase and washout in the early or delayed venous phase). Two concordant imaging techniques (triphasic CT and MRI) are needed to ascertain HCC in case of nodules between 1 and 2 cm. Biopsy is needed for making a diagnosis of HCC in patients with cirrhosis with nodules that do not fulfill the above criteria. Whatever the characteristics of the nodules, biopsy should also be performed in patients without documented cirrhosis. In case of HCC, percutaneous biopsy carries a risk of needle tract seeding of 1-2%. Percutaneous biopsy carries a potential risk of hematogenous dissemination that has not been clearly assessed. There is no clear evidence that the risk of posttransplantation recurrence is higher in patients who undergo biopsy before transplantation. Therefore, in case of HCC, previous biopsy should not be considered a contraindication for transplantation. Even though the specificity of biopsy is close to 100%, its negative predictive value is low. Negative biopsy findings do not exclude the presence of HCC. Patients with negative biopsy findings should either undergo a second biopsy or an enhanced surveillance protocol.
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Affiliation(s)
- François Durand
- Pôle des Maladies de l'Appareil Digestif, Hepatology, Hospital Beaujon, Clichy, France.
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50
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Konopke R, Bunk A, Kersting S. The role of contrast-enhanced ultrasound for focal liver lesion detection: an overview. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1515-26. [PMID: 17618038 DOI: 10.1016/j.ultrasmedbio.2007.04.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 02/21/2007] [Accepted: 04/18/2007] [Indexed: 05/16/2023]
Abstract
The development of new ultrasound (US) contrast agents and sonographic techniques has considerably improved the possibilities of ultrasound in the assessment of liver tumors. An overview is given on diagnostic potential of contrast-enhanced US (CEUS) and real-time low mechanical index technique in the detection of various focal liver lesions compared with computed tomography, magnetic resonance imaging or intraoperative US. In two of our own studies that included 100 patients each we showed an increase of correct findings in CEUS compared with B-mode US from 64% to 87% and from 67% to 84% as confirmed by intraoperative evaluation of the liver. Especially after chemotherapy and in the case of small metastases, significantly more metastases were correctly detected by CEUS compared with B-mode US. These results and clinical study results in the literature show that CEUS allows tumor detection and direct visualization of the tumor vascularity and put contrast-enhanced sonography among recommended noninvasive imaging methods for focal liver lesions with improvements in diagnostic strategy.
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Affiliation(s)
- R Konopke
- Department of Visceral, Thoracic, and Vascular Surgery, Carl Gustav Carus University Hospital, Dresden University of Technology, Dresden, Germany
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