MR comparative study of combined hepatocellular-cholangiocarcinoma in normal, fibrotic, and cirrhotic livers

Sheng, Ruo Fan; Xie, Yan; Ji, Yuan; Chen, Cai Zhong; Yang, Li; Jin, Kai; Zeng, Meng Su

doi:10.1007/s00261-016-0811-y

Cited by 15 publications

(6 citation statements)

References 21 publications

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“…As has previously been reported, 19,20 our study demonstrated that the mean tumour size of cHCC‐CCAs was significantly smaller in patients with cirrhosis than in those without cirrhosis. This finding may be explained by the more frequent imaging‐based liver surveillance performed in patients with cirrhosis, enabling detection of smaller‐sized tumours.…”

Section: Discussionsupporting

confidence: 87%

“…Our study results, with 67.3% of cHCC‐CCAs categorized as LR‐M, also fell within this range 8‐10,21,22 . Several studies have also reported that imaging features associated with cHCC‐CCAs can vary depending on the liver background 19,23 . For example, Sheng et al reported that an HCC‐like enhancement pattern (ie arterial phase hyperenhancement with washout on portal venous or delayed phases) was observed more frequently in patients with cHCC‐CCAs associated with cirrhosis than in those without cirrhosis 19 .…”

Section: Discussionmentioning

confidence: 92%

“…Several studies have also reported that imaging features associated with cHCC‐CCAs can vary depending on the liver background 19,23 . For example, Sheng et al reported that an HCC‐like enhancement pattern (ie arterial phase hyperenhancement with washout on portal venous or delayed phases) was observed more frequently in patients with cHCC‐CCAs associated with cirrhosis than in those without cirrhosis 19 . de Campos et al also reported that diffuse heterogeneous early enhancement with partial washout on later phases was more commonly identified in patients with cHCC‐CCAs associated with cirrhosis than without cirrhosis 23 .…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Yoon

Hwang

Lee

et al. 2021

Liver International

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Background and Aims Differences in combined hepatocellular‐cholangiocarcinomas (cHCC‐CCAs) arising in high‐risk patients with or without liver cirrhosis have not been elucidated. This study aimed to compare the clinicopathologic and imaging characteristics of cHCC‐CCAs in patients with or without cirrhosis and to determine the prognostic factors for recurrence‐free survival (RFS) after curative resections of single cHCC‐CCAs. Methods This retrospective study included 113 patients with surgically resected single cHCC‐CCAs who underwent preoperative magnetic resonance imaging from January 2008 to December 2019 at two tertiary referral centres. Clinical, pathologic and imaging features of tumours were compared in high‐risk patients with or without cirrhosis. Imaging features were assessed using the Liver Imaging Reporting and Data System (LI‐RADS) version 2018. RFS and associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan‐Meier analysis and log‐rank test. Results cHCC‐CCAs arising from cirrhotic livers had a smaller mean tumour size (2.9 cm vs. 4.5 cm; P < .001) and were more frequently categorized as LR‐5 or 4 (41.2% vs. 20.0%; P = .024) than those arising from non‐cirrhotic livers. In multivariable analysis, a tumour size of > 3 cm (hazard ratio [HR], 2.081; 95% confidence interval [CI], 1.180‐3.668; P = .011) and the LR‐M category (HR, 2.302; 95% CI, 1.198‐4.424; P = .012) were independent predictors associated with worse RFS. Conclusions The tumour size and distribution of LI‐RADS categories of cHCC‐CCAs differed in high‐risk patients with or without cirrhosis. And LR‐M category was a worse prognosis predictor after curative resections than LR‐5 or 4 category.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Yoon

Hwang

Lee

et al. 2021

Liver International

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“…Although pathologic diagnosis for PLC is required in patients without any risk factors for HCC development, it is important to evaluate the applicability and performance of these diagnostic imaging guidelines in these patients as it may provide insight for different imaging features of cHCC-CCA according to the presence of risk factors. For example, cHCC-CCA arising in cirrhotic liver was more likely to resemble imaging features of HCC than that arising in non-cirrhotic liver (45). Furthermore, different priorities in treatment practices among guidelines should also be taken into account when adapting these imaging guidelines to PLCs other than HCCs (46).…”

Section: Remaining Issuesmentioning

confidence: 99%

Combined Hepatocellular-Cholangiocarcinoma: Changes in the 2019 World Health Organization Histological Classification System and Potential Impact on Imaging-Based Diagnosis

Kim

Joo

et al. 2020

Korean J Radiol

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Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a primary liver cancer (PLC) with both hepatocytic and cholangiocytic phenotypes. Recently, the World Health Organization (WHO) updated its histological classification system for cHCC-CCA. Compared to the previous WHO histological classification system, the new version no longer recognizes subtypes of cHCC-CCA with stem cell features. Furthermore, some of these cHCC-CCA subtypes with stem cell features have been recategorized as either hepatocellular carcinomas (HCCs) or intrahepatic cholangiocarcinomas (ICCs). Additionally, distinctive diagnostic terms for intermediate cell carcinomas and cholangiolocarcinomas (previous cholangiolocellular carcinoma subtype) are now recommended. It is important for radiologists to understand these changes because of its potential impact on the imagingbased diagnosis of HCC, particularly because cHCC-CCAs frequently manifest as HCC mimickers, ICC mimickers, or as indeterminate on imaging studies. Therefore, in this review, we introduce the 2019 WHO classification system for cHCC-CCA, illustrate important imaging features characteristic of its subtypes, discuss the impact on imaging-based diagnosis of HCC, and address other important considerations.

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“…A few studies have evaluated the imaging characteristics of CHC based on contrast-enhanced computed tomography (CECT) [8,9] and magnetic resonance imaging (MRI) [8,10,11]. Theoretically, because CHC comprises HCC and CC components, the imaging features of both HCC and CC would be visualized, with either an HCC-like or CC-like appearance predominating [8].…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound imaging features and clinical characteristics of combined hepatocellular cholangiocarcinoma: comparison with hepatocellular carcinoma and cholangiocarcinoma

Zhang

Zhu

et al. 2020

Ultrasonography

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Purpose The purpose of this study was to retrospectively compare the clinical characteristics and imaging features on (CEUS) of combined hepatocellular cholangiocarcinoma (CHC) with those of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Methods The clinical information and CEUS features of 45 patients with CHC from 2015 to 2019 and 1-to-1-matched control subjects with HCC and CC (45 each) were compared. Results Simultaneous elevation of α-fetoprotein (AFP) and cancer antigen (CA) 19-9 was more common in CHC than in HCC and CC. In the arterial phase, hyperenhancement (homogeneous and heterogeneous) was more common in CHC (73.3%) and HCC (100%), while peripheral rim-like enhancement was more common in CC (55.6%). In the portal phase, marked washout was significantly more frequent in CHC and CC than in HCC (42.2% and 53.3% vs. 6.7%). In the delayed phase, marked washout was more common in CHC (82.2%) and CC (93.3%) than in HCC (40.0%). The washout time (WT) was much shorter in CHC and CC than in HCC (33.8±13.1 seconds and 30.1±11.6 seconds vs. 58.4±23.5 seconds). Using the combination of simultaneous elevation of AFP and CA 19-9 with marked washout in the delayed phase and a WT <38 seconds or arterial hyperenhancement to differentiate CHC from HCC or CC, the accuracy, sensitivity, and specificity were 74.4%, 93.3%, and 55.6% and 71.1%, 80.0%, and 62.2%, respectively. Conclusion Although some CEUS imaging features of CHC, HCC, and CC overlap, the combination of tumor markers and CEUS features can be helpful in differentiating CHC from HCC and CC.

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MR comparative study of combined hepatocellular-cholangiocarcinoma in normal, fibrotic, and cirrhotic livers

Abstract: MRI may provide valuable information for the diagnosis and differential diagnosis of cHCC-CC in normal, fibrotic, and cirrhotic livers. The nodule size, enhancement pattern, and the presence of mosaic architecture in cHCC-CC differ between different degrees of background liver disease.

Cited by 15 publications

References 21 publications

Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Combined Hepatocellular-Cholangiocarcinoma: Changes in the 2019 World Health Organization Histological Classification System and Potential Impact on Imaging-Based Diagnosis

Contrast-enhanced ultrasound imaging features and clinical characteristics of combined hepatocellular cholangiocarcinoma: comparison with hepatocellular carcinoma and cholangiocarcinoma

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