Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome—A study based on 3011 patients in China

Wang, P.; Meng, Zhiqiang; Chen, Zheng; Jiang, Lin; Bo, Ping; Wang, L.F.; Wang, B.H.; Liu, L.M.

doi:10.1016/j.ejso.2007.07.013

Cited by 51 publications

(45 citation statements)

References 19 publications

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“…However controversies were raised over the role of FNA in the detection of HCC. 19 These include 1) high accuracy, sensitivity and specificity of dynamic imaging modalities, 20 2) the risk of needle tract seeding 21 3) intraprocedural hematogenous dissemination 21 4) need of accurate cytohistological characterization in small well-differentiated hepatocellular lesions. 22 All these reasons preclude use of pre-operative FNA diagnosis of HCC.…”

Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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The current American Association for the Study of Liver Diseases (AASLD) guideline provides strategies for achieving the diagnosis of hepatocellular carcinoma (HCC) based on the size of liver nodules seen on surveillance imaging. For lesions less than 1 cm in size, follow-up surveillance imaging is recommended. Lesions larger than 2 cm require typical radiological hallmark on dynamic imaging. Lesions of 1-2 cm in size require typical imaging features including intense uptake of contrast during arterial phases followed by decreased enhancement during portal venous phases on at least 2 imaging modalities. In cases of atypical radiological features of the suspected lesion, tissue diagnosis either by fine needle aspiration or biopsy should be obtained. Although fine needle aspiration could give a smaller risk of seeding than biopsy, biopsy has been preferred over cytology. Percutaneous biopsy of HCC carries a potential risk of tumor seeding along the needle tract. However the risk is low and there is no clear evidence of post transplant recurrence due to needle tract seeding. Histopathologic assessment can differentiate between premalignant lesions such as dysplastic nodules and early HCC. Atypical variants of HCC can be recognized morphologically which may have associated prognostic value. ( J CLIN EXP HEPATOL 2014;4:S67-S73) H epatocellular carcinoma (HCC) is the sixth most common cancer in the world. 1 Its incidence is expected to rise in the future due to anticipated increase in cirrhosis secondary to viral hepatitis. Over the past 2 decades, the incidence of HCC has tripled, and hepatitis C virus (HCV) related HCC is the fastest-rising cause of cancer-related death in the United States. [2][3][4] Hepatocellular carcinoma develops within an established background of chronic liver disease in 70-90% of all patients. 5 The most frequent risk factor for HCC is chronic hepatitis B virus (HBV) infection in Asia and Africa. However HCV predominates as a risk factor in Europe and Japan. 2 Other well established risk factors are alcoholism, non-alcoholic fatty liver disease and diabetes. [6][7][8] Treatment depends on early diagnosis by screening high-risk patients when HCC is small and remains localized to the liver. Various studies suggest surveillance of HCC in cirrhotic patients irrespective of its etiology. Surveillance of non-cirrhotic patients is also advocated, especially in HBV carriers with serum viral load >10,000 copies/ml 9 or HCV infected patients with bridging fibrosis. Patients with HCV infection and advanced fibrosis remain at risk for HCC even after achieving sustained virological response following antiviral treatment.The preferred imaging method for screening is ultrasonography (USG) which is well tolerated and widely available. However, the sensitivity of USG for HCC detection is low because small nodules can be missed in a cirrhotic liver. 10 Use of contrast-enhanced USG improves the diagnostic performance of USG for HCC.The most used serological test in clinical setting for screening is alpha-fetop...

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Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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“…In all, 340 articles were identified (Supporting Table 1); however, only 4 level 1b studies 10-13 and 5 level 3b studies [14][15][16][17][18] could ultimately be used to answer the questions (see Tables 1 and 2). Among the 4 level 1b studies, only the study by Durand et al 13 used a completely independent reference standard (ie, an explanted liver or resection specimen).…”

Section: Analysis Question 1 What Are the Sensitivity And Specificitmentioning

confidence: 99%

Is tumor biopsy necessary?

et al. 2011

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“…If the result does not meet the criteria for HCC, a biopsy of the lesion can be performed while taking into account that a negative finding after a biopsy does not exclude HCC [1] , and the possible complications of a biopsy such as hemorrhage and needle track tumoral implant should be considered [13] . Although in a recent, long retrospective series the incidence of HCC was only 0.2% [14] , in a meta-analysis the incidence was 2.7% overall or 0.9% per year [15] .…”

Section: Diagnosismentioning

confidence: 90%

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

Soriano¹

2016

WJH

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The aim of liver transplantation (LT) for hepatocellular carcinoma (HCC) is to ensure a rate of disease-free survival similar to that of patients transplanted due to benign disease. Therefore, we are forced to adopt strict criteria when selecting candidates for LT and prioritizing patients on the waiting list (WL), to have clarified indications for bridging therapy for groups at risk for progression or recurrence, and to establish certain limits for downstaging therapies. Although the Milan criteria (MC) remain the standard and most employed criteria for indication of HCC patients for LT by far, in the coming years, criteria will be consolidated that take into account not only data regarding the size/ volume and number of tumors but also their biology. This criteria will mainly include the alpha fetoprotein (AFP) values and, in view of their wide variability, any of the published logarithmic models for the selection of candidates for LT. Bridging therapy is necessary for HCC patients on the WL who meet the MC and have the possibility of experiencing a delay for LT greater than 6 mo or any of the known risk factors for recurrence. It is difficult to define single AFP values that would indicate bridging therapy (200, 300 or 400 ng/mL); therefore, it is preferable to rely on the criteria of a French AFP model score > 2. Other single indications for bridging therapy include a tumor diameter greater than 3 cm, more than one tumor, and having an AFP slope greater than 15 ng/mL per month or > 50 ng/mL for three months during strict monitoring while on the WL. When considering the inclusion of patients on the WL who do not meet the MC, it is mandatory to determine their eligibility for downstaging therapy prior to inclusion. The upper limit for this therapy could be one lesion up to 8 cm, 2-3 lesions with a total tumor diameter up to 8 cm, or a total tumor volume of 115 cm 3 . Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future the WL should take into account the recently described HCC model for end-stage liver disease, which considers hepatic function, HCC size and the number and the log of AFP values. This formula has been calibrated with the survival data of non-HCC patients and produces a dynamic and more accurate assessment model.

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Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome—A study based on 3011 patients in China

Cited by 51 publications

References 19 publications

Tissue Diagnosis of Hepatocellular Carcinoma

Tissue Diagnosis of Hepatocellular Carcinoma

Is tumor biopsy necessary?

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

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