Contrast-enhanced intraoperative ultrasonography for vascular imaging of hepatocellular carcinoma: Clinical and biological significance

Abstract

Abnormal tumor vascularity is one of the typical features of hepatocellular carcinoma (HCC). In this study, the significance of contrast-enhanced intraoperative ultrasonography (CEIOUS) images of HCC vasculature was evaluated by clinicopathological and gene expression analyses. We enrolled 82 patients who underwent curative hepatic resection for HCC with CEIOUS. Clinicopathological and gene expression analyses were performed according to CEIOUS vasculature patterns. CEIOUS images of HCC vasculatures were classified as reticular HCC or thunderbolt HCC. Thunderbolt HCC was significantly correlated with higher alpha-fetoprotein levels, tumor size, histological differentiation, portal vein invasion, and tumor-node-metastasis stage, and these patients demonstrated a significantly poorer prognosis for both recurrence-free survival (P 5 0.0193) and overall survival (P 5 0.0362) compared with patients who had reticular HCC. Gene expression analysis revealed that a rereplication inhibitor geminin was significantly overexpressed in thunderbolt HCCs (P 5 0.00326). In vitro knockdown of geminin gene reduced significantly the proliferation of human HCC cells. Immunohistochemical analysis confirmed overexpression of geminin protein in thunderbolt HCC (P < 0.0001). Multivariate analysis revealed geminin expression to be an independent factor in predicting poor survival in HCC patients (P 5 0.0170). Conclusion: CEIOUS vascular patterns were distinctly identifiable by gene expression profiling associated with cellular proliferation of HCC and were significantly related to HCC progression and poor prognosis. These findings might be clinically useful as a determinant factor in the postoperative treatment of HCC.

Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

“…A recent meta‐analysis confirmed that a wide surgical margin (≥1 cm) can increase long‐term OS and DFS and improve prognosis in patients with HCC compared with a narrow surgical margin (<1 cm) . Locating the tumor by intraoperative laparoscopic ultrasonography and careful dissection through the laparoscopic lens make it possible to keep the intended margin . Risk of tumor seeding was another fear regarding laparoscopic resection of malignancies.…”

Therapeutic evaluation of sorafenib for hepatocellular carcinoma using contrast-enhanced ultrasonography: Preliminary result

“…Tanaka et al (23) reported that the MFI pattern classification may aid the evaluation of the differentiation grade of HCC. In addition, Sato et al (24) reported that the MFI pattern classification may be an individual predictive factor of a poor prognosis in patients with HCC. These studies suggest that the MFI findings of the intratumoral vascular architecture may aid the evaluation of the differentiation grade of HCC.…”

Ability of contrast-enhanced ultrasonography to determine clinical responses of breast cancer to neoadjuvant chemotherapy

“…Perflubutane, the contrast medium used for CEUS comprises microbubbles that do not seep into the stroma, and it can therefore display detailed images of tumor vessels and blood flow (18,19). Thus, it is a standard test to distinguish hepatomas containing tumor vessels (20) in the liver, and a factor for predicting the prognosis of hepatocellular carcinoma (32). Although CEUS has been considered useful for detecting malignant breast cancer, only a few studies (26,27) of small patient cohorts have assessed its ability to predict pCR after NAC and thus supporting evidence is insufficient.…”