Probability of hepatocellular carcinoma of small hepatocellular nodules undetectable by computed tomography during arterial portography

Tanaka, Yoshio; Sasaki, Yutaka; Katayama, Kazuhiro; Hiramatsu, Naoki; Ito, Akihiko; Murata, Hiroaki; Enomoto, N; Oshita, Masahide; Mochizuki, Kiyoshi; Tsujii, Masahiko; Tsuji, S.; Kasahara, Akinori; Tomoda, Kaname; Nakamura, Hajime; Hayashi, Norio; Hori, Masatsugu

doi:10.1053/he.2000.5979

Cited by 30 publications

(23 citation statements)

References 28 publications

(39 reference statements)

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“…12 Another study of small, well-differentiated HCCs detected by ultrasound and not seen in CT arterial portography indicated once more that in this type of tumor, it is very difficult to differentiate between malignant and benign nodules. 13 In advanced cirrhosis, as has been shown in pretransplant patients, the positive predictive value of the radiologic diagnosis decreases to less than 70%, with a false-positive rate of more than 30%. 14,15 Further, the diagnostic yield of spiral CT was recently examined in 354 pretransplant cirrhotic patients and compared with the pathology reports in the explanted livers.…”

Section: Discussionmentioning

confidence: 89%

Resection of Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Levy

Greig²,

Gallinger³

et al. 2001

Annals of Surgery

103

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ObjectiveTo evaluate the need for a preoperative tumor biopsy of liver lesions suspicious for hepatocellular carcinoma (HCC). Summary Background DataWith advances in liver imaging, the results of recent studies have suggested a very high accuracy of preoperative evaluation of liver masses suspicious of HCC, making preoperative tumor biopsy unnecessary. MethodsA retrospective analysis was conducted of all liver resections for HCC at the Toronto General and Mt. Sinai Hospitals, Toronto, between October 1994 and December 1998. ResultsSixty patients underwent 65 liver resections without a preoperative liver biopsy. The median age was 61 years. Sixty percent of the patients had cirrhosis and 38.5% had noncirrhotic chronic hepatitis. HCC was confirmed histologically in the surgical specimen in 63 of the 65 cases (96.9%). Both patients without HCC had a significant risk factor for HCC (chronic hepatitis C and alcohol in one and chronic hepatitis B and previous resection for HCC in the other). The lesions were 2 cm and 2.7 cm in diameter, and the alpha-fetoprotein level was low (Ͻ5 and 22 ng/mL, respectively). In such patients, with tumor 3 cm or smaller and an alpha-fetoprotein level less than 100 ng/mL (10 patients), the false-positive rate for the preoperative diagnosis was 2/10 (20%). ConclusionsPreoperative diagnosis of HCC was highly accurate in lesions larger than 3 cm. Tumor biopsy is unnecessary in these patients. However, in a subgroup of patients with lesions less than 3 cm, particularly those with alpha-fetoprotein levels less than 100 ng/mL, there is a higher false-positive diagnostic rate, and tumor biopsy should be considered.Hepatic resection of hepatocellular carcinoma (HCC) is a major operation in high-risk patients (mostly cirrhotic or with chronic hepatitis), with a postoperative death rate of 5% in most recent large series.

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Section: Discussionmentioning

confidence: 89%

Resection of Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Levy

Greig²,

Gallinger³

et al. 2001

Annals of Surgery

103

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“…On the other hand, when tumour nodules were smaller than 2 cm, it was difficult to distinguish between benign nodules and malignant ones with imaging techniques including ultrasonography and computed tomography during arterial portography [37]. The overall sensitivity of helical CT during arterial portography for the detection of HCC in the presence of liver cirrhosis is only about 70%, with lower values (25–28%) for lesions <2 cm [38].…”

Section: Discussionmentioning

confidence: 99%

Application of Classification Tree and Neural Network Algorithms to the Identification of Serological Liver Marker Profiles for the Diagnosis of Hepatocellular Carcinoma

Poon

Chan²,

Zee³

et al. 2001

Oncology

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Objective: Although many attempts have been made to identify tumour-specific α-fetoprotein (AFP) glycoforms or other serological markers for the diagnosis of hepatocellular carcinoma (HCC), none of the available markers has, so far, shown satisfactory sensitivity and specificity. Here we aimed to apply classification tree and neural network algorithms to interpret the levels of multiple serological liver markers to improve overall specificity and sensitivity, particularly with a view to discriminating between liver cirrhosis with and without HCC. Methods: We developed classification trees and neural networks that identified serological liver marker profiles comprising AFP, α1-antitrypsin (A1AT), α2-macroglobulin (A2MG), thyroxine-binding globulin (TBG), transferrin and albumin as well as sex and age, which might permit the diagnosis of HCC. Data were collected from 65 HCC patients, 51 patients with liver cirrhosis alone (LC) and 51 normal healthy subjects. Results: The generated classification trees and neural networks showed similar diagnostic values in differentiating HCC from LC. The classification trees identified AFP, A1AT and albumin as the most important classification parameters, whereas the neural networks identified A2MG, AFP, A1AT and albumin as the predominant factors. The classification logic of the classification trees indicated that more HCC cases could be identified among cases with slightly elevated AFP levels by using the serum levels of A1AT and albumin. The neural networks were also useful for the identification of the HCC cases when the AFP levels were below 500 ng/ml (p < 0.005). The neural networks could identify HCC cases with AFP levels within the normal range, but the classification trees could not. By combining the conventional AFP test and the neural networks, the overall diagnostic sensitivity for HCC was significantly increased from 60.0 to 73.8% (p < 0.05) while maintaining a high specificity (88.2%). The sensitivities for tumors of different sizes were similar. Conclusion: The neural network algorithm appeared to be more powerful than the classification tree algorithm in the identification of the distinctive serological liver marker profiles for the diagnosis of the HCC subgroup without significant elevation in serum AFP levels. By incorporating serological levels of other liver markers and including data from a large number of patients and control subjects, it should prove possible to develop a versatile neural network for early diagnosis of HCC.

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“…During the last decade, advances in cross-sectional imaging [1][2][3][4][5] has lead to a drastic limitation of liver nodules biopsy. In the guidelines from the European Association for the Study of the Liver (EASL) Conference in Barcelona, 6 the use of ultrasound (US) guided FNB for the diagnosis of nodules in cirrhosis has been limited to those ranging from 10 to 20 mm in diameter.…”

Section: Role Of Fine-needle Biopsy and The European Association For mentioning

confidence: 99%

“…[1][2][3][4][5] A study from Japan 14 compared digital subtraction angiography, magnetic resonance imaging, and US-guided biopsy for the diagnosis of 180 HCC nodules Յ20 mm in diameter. Only 68% of the lesions measuring 11 to 20 mm in diameter could be diagnosed by imaging, the others required biopsy.…”

Section: Complications Of Fine-needle Biopsymentioning

confidence: 99%

“…Various reports have emphasized the underestimation of imaging techniques for extension of HCC nodules when compared to serial pathologic explanted livers. 21,22 Nevertheless, US is probably the most accurate imaging modality for visualizing small liver nodules, 3,4,17 and US follow-up of high-risk cirrhotic patients has become widespread in clinical practice because early detection of HCC 23,24 improves the prognosis. 25,26 …”

Section: Diagnostic Role Of Us For Hcc Detectionmentioning

confidence: 99%

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Fine needle biopsy of focal liver lesions: The hepatologist's point of view

et al. 2004

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Guided biopsy of hepatocellular carcinoma has been recently discussed again due to the progress of imaging techniques and the risk of malignant seeding after the procedure. Ultrasound is probably still the most accurate imaging modality for early detection of nodules arising on cirrhosis, even when compared with more advanced imaging techniques. It can be easily employed in the surveillance of high-risk cirrhotic patients. Ultrasound-guided biopsy has very high sensitivity and almost absolute specificity, which allows the appropriate treatment to start after a positive diagnosis. It also allows correct diagnosis of lymphomatous nodules, the incidence of which is increased in hepatitis C virus-related cirrhosis. The risk of seeding appears limited according to the currently available epidemiological data; this should be considered against the risk of false-positive diagnosis of malignancy based on imaging studies alone. Ultrasound-guided biopsy is a valuable tool also for the diagnosis of small nodules (less than 10 mm in diameter). The best accuracy in the sampling of hepatocellular carcinoma nodules is obtained by combining smear cytology and microhistology. This can be achieved by a single biopsy with a fine cutting needle that furnishes pathologic material suitable for both examinations, reducing risks and costs.

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Probability of hepatocellular carcinoma of small hepatocellular nodules undetectable by computed tomography during arterial portography

Cited by 30 publications

References 28 publications

Resection of Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Resection of Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

Application of Classification Tree and Neural Network Algorithms to the Identification of Serological Liver Marker Profiles for the Diagnosis of Hepatocellular Carcinoma

Fine needle biopsy of focal liver lesions: The hepatologist's point of view

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