Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres

Abstract

We present the correlation between radiologic and pathologic findings in HCC patients who underwent radioembolization with yttrium-90 ( 90 Y) microspheres prior to resection or transplantation. Thirty-five patients with a total of 38 lesions who underwent liver explantation after 90 Y radioembolization were studied. Imaging surrogates following treatment were evaluated; the explants were examined for assessment of necrosis by pathology. The correlation betwen radiologic and histologic findings of the treated lesions was analyzed. Twenty-three of 38 (61%) target lesions showed complete pathologic necrosis. All target lesions demonstrated some degree of histologic necrosis at explant. Complete histologic necrosis was seen in 89% of lesions with pretreatment size <3 cm. Complete pathologic necrosis was seen in 100%, 78%, and 93% of the lesions that were shown to have complete response by European Association for the Study of the Liver (EASL) necrosis criteria, partial response by World Health Organizaton (WHO) criteria, or thin rim enhancement on posttreatment imaging, respectively. In contrast, complete pathologic necrosis was seen in only 52% and 38% of the lesions that showed partial response by EASL criteria and peripheral nodular enhancement, respectively. Conclusion: Post-radioembolization imaging findings of response by EASL and WHO criteria are predictive of the degree of pathologic necrosis. Rim enhancement was an imaging characteristic that correlated well with histologic necrosis.

Is the treatment of hepatocellular carcinoma on the waiting list necessary?

“…8 Other confirmatory studies have shown that the technique can be used safely in pretransplant patients and that the percutaneous route is as safe as the laparoscopic approach and less cumbersome. 9,10 In pathological studies, the results for RFTA appear to be superior to those for TACE, 37,38 and RFTA appears to be associated with less tumor progression. 18 The prevalence of viable cells can be easily assessed in explant specimens.…”

“…In a study that reported the correlation between radiological and pathological findings in patients with HCC who underwent radioembolization with yttrium-90 microspheres before transplantation, all target lesions demonstrated some degree of histological necrosis, and 23 of 38 (61%) showed complete pathological necrosis. 38 A recent study retrospectively analyzed transarterial radioembolization (TARE) and TACE in similar patients (122 and 123, respectively); 44 TARE patients and 46 TACE patients were at stage T2 (they were not analyzed separately). 42 Although there was no survival benefit for TARE, the time to disease progression and the AFP responses were significantly more favorable with TARE, and this suggests that this treatment could be a promising modality before OLT.…”

Computed Tomography Imaging Assessment of Postexternal Beam Radiation Changes of the Liver

“…Previously included in size criteria, the newer criteria account for necrosis and exclude these regions from tumor measurements. Some studies have confirmed the usefulness of these criteria for yttrium radiation [20,21], but radiological studies have failed to demonstrate a similar value in external beam radiation. Studies have concluded that mRECIST is useful for correlation with prognosis and as a framework for clinical trial design, but should not be used for routine clinical practice due to its inaccuracy in estimating viable tumor correctly [22,23].…”

Current and Future Challenges in the Surgical Treatment of Hepatocellular Carcinoma: A Review

“…51 A closely related alternative has been the use of Yttrium-90 microsphere embolization through the hepatic artery, as a method of radioembolization, which has shown remarkable results, even in advanced cases such as those with portal vein thrombosis. 52 Finally, newer methods of locoregional treatment are being developed and tested, including the irreversible electroporation, which is a technique that increases membrane permeability by changing the transmembrane potential. Its advantage is that it can deliver very high amounts of energy with high speed, making it faster than the ablation methods, as well as safer; because it is not thermal ablation, it can be used for lesions close to blood vessels.…”