Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

Abstract

Background: To evaluate the segmental distribution of hepatocellular carcinoma (HCC) according to Couinaud’s anatomical division in cirrhotic patients. Methods: Between 2020 and 2021, a total of 322 HCC nodules were diagnosed in 217 cirrhotic patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) for the evaluation of suspicious nodules (>1 cm) detected during ultrasound surveillance. For each patient, the segmental position of the HCC nodule was recorded according to Couinaud’s description. The clinical data and nodule characteristics were collected. Results: A total of 234 (72.7%) HCC nodules were situated in the right lobe whereas 79 (24.5%) were detected in the left lobe (p < 0.0001) and only 9 nodules were in the caudate lobe (2.8%). HCC was most common in segment 8 (n = 88, 27.4%) and least common in segment 1 (n = 9, 2.8%). No significant differences were found in the frequencies of segmental or lobar involvement considering patient demographic and clinical characteristics, nodule dimension, or disease appearance. Conclusions: The intrahepatic distribution of HCC differs among Couinaud’s segments, with segment 8 being the most common location and segment 1 being the least common. The segmental distribution of tumour location was similar to the normal liver volume distribution, supporting a possible correlation between HCC location and the volume of hepatic segments and/or the volumetric distribution of the portal blood flow.

Evaluation of the effectiveness of surgical resection and ablation for the treatment of early‐stage hepatocellular carcinoma: A retrospective cohort study

“…The segmental distribution of HCC has been previously reported to be proportional to the volume of the liver lobe or other lobes. 37 In this study, a high incidence of HCC was observed in the right lobe of the liver (74.3%), mainly in hepatic segments V, VII and VIII, consistent with the findings reported by Renzulli et al 38 Tumor location in segment VIII, which is proximal to the diaphragm, was identified as an important factor influencing the effectiveness of ablation, and location in this segment was associated with a 3.5-fold greater risk of microvascular invasion (MVI) than location in other liver segments. Notably, local recurrence of HCC in segments VII and VIII occurred after ablation.…”

Association between anatomic variations of extrahepatic and intrahepatic bile ducts: Do look up!

“…Intrahepatic biliary duct (IHBD) anatomy is coincident with liver segmental anatomy according to the Couinaud classification (Renzulli, Brocchi, et al, 2022). In “conventional” anatomy (Cucchetti et al, 2011; Puente & Bannura, 1983; Yoshida et al, 1996), the right hepatic duct (RHD) is formed by the fusion of its two major branches the right posterior duct (RPD), draining the posterior segments of the right liver lobe (segments 6 and 7), and the right anterior duct (RAD), draining the anterior segments of the right liver lobe (segments 5 and 8).…”

The Feasibility of Liver Biopsy for Undefined Nodules in Patients under Surveillance for Hepatocellular Carcinoma: Is Biopsy Really a Useful Tool?

“…Smaller nodules, ranging from 10–20 mm, are less prone to being punctured, as they can be faintly seen on US, which, in the majority of cases, is used as a guide for liver biopsy. The segment location may also represent an obstacle [ 38 ]. In this study, only segment six was a positive independent prognostic factor for biopsy, probably due to the better visualisation of, and approach to, this portion of the liver through US.…”