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Zeng D, Xu M, Liang JY, Cheng MQ, Huang H, Pan JM, Huang Y, Tong WJ, Xie XY, Lu MD, Kuang M, Chen LD, Hu HT, Wang W. Using new criteria to improve the differentiation between HCC and non-HCC malignancies: clinical practice and discussion in CEUS LI-RADS 2017. Radiol Med 2021; 127:1-10. [PMID: 34665430 DOI: 10.1007/s11547-021-01417-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Using contrast-enhanced ultrasound (CEUS) to evaluate the diagnostic performance of liver imaging reporting and data system (LI-RADS) version 2017 and to explore potential ways to improve the efficacy. METHODS A total of 315 nodules were classified as LR-1 to LR-5, LR-M, and LR-TIV. New criteria were applied by adjusting the early washout onset (< 45 s) and the time of marked washout (within 3 min). Two subgroups of the LR-M nodules were recategorized as LR-5, respectively. The diagnostic performance was evaluated by calculating the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS By adjusting early washout onset to < 45 s, the LR-5 as a standard for diagnosing HCC had an improved sensitivity (74.1% vs. 56.1%, P < 0.001) without significant change in PPV (93.3% vs. 96.1%, P = 0.267), but the specificity was decreased (48.3% vs. 78.5%, P = 0.018). The LR-M as a standard for the diagnosis of non-HCC malignancies had an increase in specificity (89.2% vs. 66.2%, P < 0.001) but a decrease in sensitivity (31.5% vs. 68.4%, P = 0.023). After reclassification according to the time of marked washout, the sensitivity of the LR-5 increased (80% vs. 56.1%, P < 0.001) without a change in PPV (94.9% vs. 96.1%, P = 0.626) and specificity (80% vs. 78.5%, P = 0.879). For reclassified LR-M nodules, the specificity increased (87.5% versus 66.2%, P < 0.001) with a non-significant decrease in sensitivity (47.3% vs. 68.4%, P = 0.189). CONCLUSIONS The CEUS LI-RADS showed good confidence in diagnosing HCC while tended to misdiagnose HCC as non-HCC malignancies. Adjusting the marked washout time within 3 min would reduce the possibility of this misdiagnosis.
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Affiliation(s)
- Dan Zeng
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ming Xu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Jin-Yu Liang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Mei-Qing Cheng
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Hui Huang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Jia-Ming Pan
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yang Huang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Wen-Juan Tong
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.
| | - Wei Wang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
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Evaluation of AGP Fucosylation as a Marker for Hepatocellular Carcinoma of Three Different Etiologies. Sci Rep 2019; 9:11580. [PMID: 31399619 PMCID: PMC6689003 DOI: 10.1038/s41598-019-48043-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/26/2019] [Indexed: 02/08/2023] Open
Abstract
A mass spectrometric analysis platform has been developed to determine whether glycosylation patterns of alpha-1 acid glycoprotein (AGP) could be used as a marker for early detection of hepatocellular carcinoma (HCC) in different etiologies, i.e. non-alcoholic steatohepatitis (NASH), alcoholic liver disease (ALC), and hepatitis C virus (HCV). MALDI-MS profiling of N-glycans of AGP purified from 20 μL of patient serum in HCC (n = 72) and liver cirrhosis (n = 58) showed that a unique trifucosylated tetra-antennary glycan (m/z 3490.76) was predominantly identified in HCCs but was absent in healthy subjects and the majority of cirrhosis patients. Receiver operation characteristic (ROC) curve analysis showed that the trifucosylated N-glycan of AGP (triFc_AGP) could differentiate HCC from cirrhosis with an area under the curve (AUC) of 0.707, 0.726 and 0.751 for NASH, ALC and HCV, respectively. When combining triFc_AGP with INR and AFP, the panel had the greatest benefit in detection of NASH-related HCCs, with a significantly improved AUC of 0.882 for all NASH HCCs and 0.818 for early NASH HCCs compared to AFP alone (0.761 and 0.641, respectively). Moreover, triFc_AGP could serve as a potential marker for monitoring AFP-negative HCC patients.
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Hepatocellular Carcinoma Screening Utilising Serum Alpha-Fetoprotein Measurement and Abdominal Ultrasound Is More Effective than Ultrasound Alone in Patients with Non-viral Cirrhosis. J Gastrointest Cancer 2019; 49:476-480. [PMID: 28920172 DOI: 10.1007/s12029-017-0006-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study is aimed to determine the performance of alpha-fetoprotein (AFP) as part of hepatocellular carcinoma (HCC) screening in a non-viral cirrhosis population. METHODS A retrospective audit was conducted of patients with non-viral cirrhosis over a 13 year period managed at a single centre. All patients were investigated routinely for evidence of viral hepatitis; patients with positive results were excluded from analysis. Cirrhosis was defined on basis of clinical, biochemical, and radiological investigations and examinations. All patients underwent HCC screening with 6-monthly AFP measurement and 6-12-monthly upper abdominal ultrasound (US). Diagnosis of HCC was confirmed by biopsy, definitive imaging, or natural disease progression. RESULTS Sixty-seven patients were included (49 males, average age 58.7 years). Of 14 patients who developed HCC during the study period, 12 patients had HCC detected via screening. Of the screening diagnosed HCC cases, four (33%) patients had a normal AFP with abnormal surveillance US, three (25%) had raised AFP with normal surveillance US, and five (42%) had concurrent AFP elevation and US abnormality. Patients with raised AFP and normal surveillance US had HCC diagnosed after a progressive rise in AFP precipitated imaging with alternative modalities. Within the 53 patients who remained free of HCC, a raised AFP precipitated additional imaging on 10 occasions. HCC was diagnosed in 12 out of 64 patients over a total of 4292 screening months giving an annual incidence of 3.35%. CONCLUSIONS Twenty-five percent of HCC occurring in non-viral cirrhosis will be detected earlier using a surveillance program incorporating both AFP and US compared to imaging alone programs.
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Samoylova ML, Mehta N, Roberts JP, Yao FY. Predictors of Ultrasound Failure to Detect Hepatocellular Carcinoma. Liver Transpl 2018; 24:1171-1177. [PMID: 29781162 DOI: 10.1002/lt.25202] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/31/2018] [Indexed: 12/13/2022]
Abstract
Current guidelines recommend ultrasound (US) for hepatocellular carcinoma (HCC) surveillance in cirrhosis. We assess predictors of decreased US sensitivity for detecting HCC. At a single center in the United States, all HCC patients evaluated for liver transplantation (LT) received an abdominal US. From 2007-2015, consecutive patients presenting for untreated lesions found on computed tomography (CT) or magnetic resonance imaging (MRI) within 3 months of US were compared with US findings. Multivariate logistic regression models compared US sensitivities by patient characteristics. Of 1007 patients completing LT evaluation, 47.5% had indeterminate or previously treated nodules and were excluded; 10.4% had imaging that was too far apart or nondiagnostic. Median Model for End-Stage Liver Disease (MELD) of the cohort (n= 352) was 11 (interquartile range [IQR], 9-14), median body mass index (BMI) was 28 kg/m2 (IQR, 25-32 kg/m2 ), 39% had received locoregional therapy, and 10% had moderate/large ascites. Per-patient sensitivity of US compared with CT/MRI was 0.82 (95% confidence interval, 0.76-0.86). Patients with BMI ≥ 30 kg/m2 had a US sensitivity of 0.76 versus 0.87 for BMI < 30 kg/m2 (P = 0.01). MELD and ascites did not affect sensitivity. US sensitivity was decreased in patients with nonalcoholic steatohepatitis (NASH) versus other etiologies (0.59 versus 0.84; P = 0.02). Relative to CT/MRI, US is significantly less sensitive in patients with NASH or BMI ≥ 30 kg/m2 . Further study is necessary to examine the added value of cross-sectional imaging for patients with NASH or obesity.
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Affiliation(s)
| | - Neil Mehta
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| | - John P Roberts
- Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
| | - Francis Y Yao
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA.,Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
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5
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Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, Waljee AK, Singal AG. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology 2018; 154:1706-1718.e1. [PMID: 29425931 PMCID: PMC5927818 DOI: 10.1053/j.gastro.2018.01.064] [Citation(s) in RCA: 665] [Impact Index Per Article: 110.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis. METHODS Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. RESULTS Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%-92%), but early-stage HCC with only 47% sensitivity (95% CI 33%-61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83-0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71-0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05-1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%-75%) and 45% sensitivity (95% CI 30%-62%), respectively (P = .002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%-92%). CONCLUSIONS We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.
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Affiliation(s)
- Kristina Tzartzeva
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Joseph Obi
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Nicole E Rich
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jorge A Marrero
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Adam Yopp
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Akbar K Waljee
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas.
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6
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Zhao C, Jin M, Le RH, Le MH, Chen VL, Jin M, Wong GLH, Wong VWS, Lim YS, Chuang WL, Yu ML, Nguyen MH. Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta-analysis of a complex issue. Liver Int 2018; 38:503-514. [PMID: 28834146 DOI: 10.1111/liv.13555] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) surveillance is associated with improved outcomes and long-term survival. Our goal is to evaluate adherence rates to HCC surveillance. METHODS We performed a systematic search of the PubMed and Scopus databases and abstract search of relevant studies from recent major liver meetings. All searches and data extraction were performed independently by two authors. Analysis was via random-effects models and multivariate meta-regression. RESULTS A total of 22 studies (n = 19 511) met inclusion criteria (original non-interventional studies with defined cirrhosis or chronic hepatitis B or chronic hepatitis C with advanced fibrosis populations, and surveillance tests and intervals). Overall adherence rate was 52% (95% CI 38%-66%). Adherence was significantly higher in cirrhotic patients compared to chronic hepatitis B and other high-risk patients, in European compared to North American studies, in less than 12-month compared to yearly surveillance intervals, and in prospective compared to retrospective studies (71%, 95% CI 64%-78% vs 39%, 95% CI 26%-51%, P < .001). The between-study heterogeneity of all above analyses was significant (P < .001). Only the study design (retrospective vs prospective cohort) had statistical significance in a multivariate meta-regression model (P < .05) and could account for some of the differences above. CONCLUSIONS Overall adherence rate to HCC surveillance was suboptimal at 52% with no significant differences by liver disease aetiology or study location in multivariate meta-regression analysis. Further research and educational efforts are needed to improve the current rate of HCC surveillance.
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Affiliation(s)
- Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T. C. M., Shanghai, China.,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mingjuan Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Richard Hieu Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Vincent Lingzhi Chen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Michelle Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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Terzi E, Iavarone M, Pompili M, Veronese L, Cabibbo G, Fraquelli M, Riccardi L, De Bonis L, Sangiovanni A, Leoni S, Zocco MA, Rossi S, Alessi N, Wilson SR, Piscaglia F. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. J Hepatol 2018; 68:485-492. [PMID: 29133247 DOI: 10.1016/j.jhep.2017.11.007] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/28/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The use of contrast enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis was questioned because of the risk of a false positive diagnosis in cases of cholangiocarcinoma. The American College of Radiology has recently released a scheme (CEUS Liver Imaging Reporting and Data System [LI-RADS®]) to classify lesions at risk of HCC investigated by CEUS. The aim of the present study was to validate this LI-RADS scheme for the diagnosis of HCC. METHODS A total of 1,006 nodules from 848 patients with chronic liver disease at risk of HCC were collected in five Italian centers and retrospectively analyzed. Nodules were classified as LR-5, (HCC) if ≥1 cm with arterial phase hyperenhancement, and late washout (onset ≥60 s after contrast injection) of mild degree. Rim enhancement and/or early and/or marked washout qualified lesions as LR-M (malignant, but not specific for HCC). Other combinations qualified lesions at intermediate risk for HCC (LR-3) or probable HCC (LR-4). Diagnostic reference standard was CT/MRI diagnosis of HCC (n = 506) or histology (n = 500). RESULTS The median nodule size was 2 cm. Of 1,006 nodules, 820 (81%) were HCC, 40 (4%) were cholangiocarcinoma, 116 (11%) regenerative nodules (±dysplastic). The LR-5 category (52% of all nodules) was 98.5% predictive of HCC, with no risk of misdiagnosis for pure cholangiocarcinoma. Sensitivity for HCC was 62%. All LR-M nodules were malignant and the majority of non-hepatocellular origin. Over 75% of cholangiocarcinomas were LR-M. The LR-3 category included 203 lesions (HCC 96 [47%]) and the LR-4 202 (HCC 173 [87%]). CONCLUSIONS The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. LAY SUMMARY This is a retrospective study of approximately 1,000 focal lesions at risk for hepatocellular carcinoma (HCC). Herein, we demonstrate that the refined definition of the typical contrast enhanced ultrasound pattern of HCC introduced by the Liver Imaging Reporting and Data System (LI-RADS®) practically abolishes the risk of misdiagnosis of other malignant entities (e.g. cholangiocarcinoma) for HCC with negligible reduction in sensitivity. These data support the use of contrast enhanced ultrasound to diagnose HCC in cirrhosis.
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Affiliation(s)
- Eleonora Terzi
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Iavarone
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Maurizio Pompili
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Letizia Veronese
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Mirella Fraquelli
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Laura Riccardi
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Ludovico De Bonis
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angelo Sangiovanni
- A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy
| | - Simona Leoni
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Assunta Zocco
- Internal Medicine, Gastroenterology and Hepatology, Gemelli Hospital, University of Rome, Rome, Italy
| | - Sandro Rossi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Nicola Alessi
- Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Stephanie R Wilson
- Radiology and Medicine, Division of Gastroenterology, University of Calgary, Canada
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Park JH, Park MS, Lee SJ, Jeong WK, Lee JY, Park MJ, Han K, Nam CM, Park SH, Lee KH. Contrast-enhanced US with Perfluorobutane(Sonazoid) used as a surveillance test for Hepatocellular Carcinoma (HCC) in Cirrhosis (SCAN): an exploratory cross-sectional study for a diagnostic trial. BMC Cancer 2017; 17:279. [PMID: 28420329 PMCID: PMC5395905 DOI: 10.1186/s12885-017-3267-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/05/2017] [Indexed: 02/08/2023] Open
Abstract
Background Ultrasonography (US) is widely used as a standard surveillance tool for patients who are at a high risk of having hepatocellular carcinoma (HCC); however, conventional B-mode US appears to be insufficient in order to ensure the early detection of HCC. Perfluorobutane allows very stable Kupffer phase imaging for at least 60 min, which is tolerable for examinations of the entire liver. The purpose of our study is to evaluate the added value of contrast-enhanced US using perfluorobutane to that of conventional B-mode US as an HCC surveillance tool for patients with liver cirrhosis. Methods/Design SCAN (Sonazoid-US for surveillance of hepatoCellulArcarciNoma) is a prospective, multi-institutional, diagnostic trial using an intra-individual comparison design in a single arm of patients. This study was approved by our five institutional review board and informed consent was obtained from all participating. We obtained consent for publication of these data (contrast enhanced US images, CT or MRI images, laboratory findings, age, sex) from all participating patients. All patients will undergo conventional B-mode US immediately followed by contrast-enhanced US. The standardized case report forms will be completed by operating radiologists after B-mode US and contrast-enhanced US, respectively. If any lesion(s) is detected, the likelihood of HCC will be recorded. The primary endpoints are a detection rate of early-stage HCC and a false referral rate of HCC. Intra-individual comparison using Mcnemar’s test will be performed between B-mode US and contrast-enhanced US. The study will include 523 patients under HCC surveillance in five medical institutions in Korea. Discussion SCAN is the first study to investigate the efficacy of contrast-enhanced US in surveillance using two reciprocal endpoints specialized for the evaluation of a surveillance test. SCAN will provide evidence regarding whether patients can truly benefit from contrast-enhanced US in terms of the detection of early stage HCC while avoiding additional unnecessary examinations. In addition to the study protocol, we elaborate on potentially debatable components of SCAN, including the design of an intra-individual comparison study, study endpoints, composite reference standards, and indefinite imaging criteria regarding the likelihood of HCC. Trial registration The date of trial registration (ClincalTrials.gov: NCT02188901) in this study is July 3, 2014. The last patient enrolled in August 30, 2016 and follow up to see the primary end point is still ongoing. All authors have no other relationships/conditions/circumstances that present a potential conflict of interest of relationships. Our study protocol has undergone peer-review by the funding body (GE Healthcare). No other relationships/conditions/circumstances that present a potential conflict of interest. Also, we clearly stated in the 'competing interests' section of my manuscript.
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Affiliation(s)
- Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Gyeonggi-do, Republic of Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Jung Park
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyunghwa Han
- Yonsei Biomedical Research Institute, Department of Radiology, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Gyeonggi-do, Republic of Korea
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Tanabe K, Kitagawa K, Kojima N, Iijima S. Multifucosylated Alpha-1-acid Glycoprotein as a Novel Marker for Hepatocellular Carcinoma. J Proteome Res 2016; 15:2935-44. [PMID: 27354006 DOI: 10.1021/acs.jproteome.5b01145] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-sensitivity and -specificity diagnostic techniques to detect early-stage hepatocellular carcinoma (HCC) are in high demand. Screening with serum HCC markers, such as alpha-fetoprotein, is not practical because they possess poor sensitivity and specificity. As such, we focused on glycan alterations of glycoproteins found in patient sera in an attempt to discover novel HCC markers that are more specific and sensitive than current HCC markers. Sera from 42 HCC patients and 80 controls, composed of 27 chronic hepatitis B patients, 26 chronic hepatitis C patients, and 27 healthy volunteers, were analyzed in this study. Glycopeptides obtained from serum proteins by trypsin digestion were enriched by ultrafiltration and Aleuria aurantia lectin-based affinity chromatography, followed by analysis using liquid chromatography time-of-flight mass spectrometry. The data were analyzed by our newly developed software, which calculates peak intensities and positions (m/z and elution time), aligns all sample peaks, and integrates all data into a single table. HCC markers were extracted from more than 30 000 detected glycopeptide peaks by t test, mean-fold change, and ROC analyses. As a result, we revealed that alpha-1-acid glycoprotein with multifucosylated tetraantennary N-glycans was significantly elevated in HCC patients, whereas the single fucosylated derivative was not.
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Affiliation(s)
- Kazuhiro Tanabe
- Advanced Technology Center, Medical Solution Segment, LSI Medience Corporation , Tokyo 174-8555, Japan
| | - Kae Kitagawa
- Biotechnology Laboratory, Mitsubishi Chemical Group Science and Technology Research Center, Inc. , Yokohama 227-8502, Japan
| | - Nozomi Kojima
- Biotechnology Laboratory, Mitsubishi Chemical Group Science and Technology Research Center, Inc. , Yokohama 227-8502, Japan
| | - Sadayo Iijima
- International Sales Department, LSI Medience Corporation , Tokyo 101-8517, Japan
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Bose PP, Mandal G, Kumar D, Duseja A, Chatterjee BP. Visual detection of serum asialohaptoglobin by plasmonic sandwich ELLSA--a new platform for cirrhosis diagnosis. Analyst 2015; 141:76-84. [PMID: 26568048 DOI: 10.1039/c5an02000j] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The cirrhotic condition of the liver has long been acknowledged as the preface to liver cancer. The desialylation status of the serum acute phase protein, haptoglobin, has been introduced as a new diagnostic analyte for liver cirrhosis. The reliability of this new diagnostic molecule has been evaluated in 30 liver cirrhosis patients having a history of earlier viral hepatitis C (HCV-LC). A novel enzyme linked lectinosorbent assay has been developed coupled with the plasmon mechanism of gold nanoparticle aggregation as the colorimetric read out which can visually distinguish the cirrhotic liver patients from the normal healthy and hepatitis C controls. The assay can be useful for rapid point-of-care detection, and even an untrained person can execute it without a specialized instrument. This method employs Sambucus nigra agglutinin (SNA) to detect the extent of α-2,6 sialylation of serum haptoglobin, the new diagnostic molecule for liver cirrhosis.
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Affiliation(s)
- Partha Pratim Bose
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research, Hajipur 844102, India.
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Serum fucosylated paraoxonase 1 as a potential glycobiomarker for clinical diagnosis of early hepatocellular carcinoma using ELISA Index. Glycoconj J 2015; 32:119-25. [PMID: 25702281 DOI: 10.1007/s10719-015-9576-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
Abstract
Serum paraoxonase 1 (PON1) is highly fucosylated in hepatocellular carcinoma (HCC) compared with liver cirrhosis (LC). Herein, lectin ELISA using Aleuria aurantia lectin (AAL) was established, which specifically measured optical density (OD) value of serum fucosylated PON1. PON1 protein ELISA was applied simultaneously. ELISA Index (OD value of fucosylated PON1/OD value of protein PON1) was introduced to indicate PON1 fucosylation level on its protein level (Fuc-PON1). ELISA Index in training group (90 LC and 90 HCC) was measured and area under the ROC curve (AUROC) was 0.803 with 80 % of sensitivity and 64.4 % of specificity in distinguishing early HCC from LC. Within training group, AFP(-) HCC (20/90) exhibited better AUROC (0.850), higher sensitivity (90 %) and specificity (75 %) than AFP(+) HCC (70/90). An independent testing set (20 LC and 20 HCC) validated the model and 17 HCC patients were successfully predicted. Meanwhile, serum AFP of 43 LC and 43 HCC had an AUROC of 0.760 with sensitivity of 79.1 % and specificity of 53.5 %. Thus, Fuc-PON1 may serve as a glycan biomarker for distinguishing early HCC from LC patients even with low AFP levels.
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de Sio I, Iadevaia MD, Vitale LM, Niosi M, Del Prete A, de Sio C, Romano L, Funaro A, Meucci R, Federico A, Loguercio C, Romano M. Optimized contrast-enhanced ultrasonography for characterization of focal liver lesions in cirrhosis: A single-center retrospective study. United European Gastroenterol J 2014; 2:279-87. [PMID: PMID: 25083285 PMCID: PMC4114116 DOI: 10.1177/2050640614538964] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/12/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the leading cause of death amongst cirrhotic patients. Its diagnosis and discrimination from non-HCC malignant lesions in cirrhosis includes contrast enhanced computed tomography (CECT), contrast enhanced magnetic resonance imaging (CEMRI), or, in selected cases, liver biopsy. The role of contrast-enhanced ultrasonography (CEUS) is still controversial. AIMS To evaluate whether, by selecting an appropriate 'time to wash-out' cut-off value, CEUS capability of discriminating between HCC and non-HCC malignancies in cirrhotic patients may be enhanced. METHODS We enrolled 282 cirrhotic patients who underwent CEUS at our institute, from January 2008 to January 2012, for focal liver lesions (FLLs) detected at ultrasound (US). We used liver biopsy and subsequent histological evaluation as the gold standard for correct classification of FLLs. We calculated the area under receiver operator characteristic curves for CEUS to distinguish patients with HCC from those with non-HCC malignancies. The best 'time to wash-out' cut-off values were selected. RESULTS HISTOLOGICAL DIAGNOSIS OF FLLS WAS AS FOLLOWS: 34 benign lesions (i.e. 25 regenerative nodules and 9 dysplastic nodules) and 248 malignant lesions (223 well-to-moderately differentiated HCCs; 7 poorly-differentiated HCCs; 5 intrahepatic colangiocellular carcinomas (ICCs); 5 primary non-Hodgkin B-cell lymphomas (NHBLs); and 8 metastatic liver tumors). A time to wash-out > 55 s identified patients with HCC with the highest level of accuracy (92.7%). Similarly, a time to wash-out ≤ 55 s correctly identified the vast majority of the non-HCC malignancies (100% sensitivity, 98.2% specificity and diagnostic accuracy of 98.3%). CONCLUSIONS CEUS is an accurate and safe procedure for discriminating FLLs in cirrhotic patients, especially when a cut-off time to wash-out of 55 s is chosen as a reference value.
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Affiliation(s)
- Ilario de Sio
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Maddalena D Iadevaia
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Luigi M Vitale
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Marco Niosi
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Anna Del Prete
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Chiara de Sio
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Lorenzo Romano
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Annalisa Funaro
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Rosaria Meucci
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Alessandro Federico
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Carmelina Loguercio
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
| | - Marco Romano
- Department of Clinical and Experimental Medicine 'Magrassi-Lanzara', Second University of Naples, Naples, Italy
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Evidence of diagnostic enhancement pattern in hepatocellular carcinoma nodules ≤2 cm according to the AASLD/EASL revised criteria. ACTA ACUST UNITED AC 2013; 38:1245-53. [DOI: 10.1007/s00261-013-0031-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Pocha C, Dieperink E, McMaken KA, Knott A, Thuras P, Ho SB. Surveillance for hepatocellular cancer with ultrasonography vs. computed tomography -- a randomised study. Aliment Pharmacol Ther 2013; 38:303-12. [PMID: 23750991 DOI: 10.1111/apt.12370] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/20/2013] [Accepted: 05/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Guidelines recommend screening for hepatocellular cancer (HCC) with ultrasonography. The performance of ultrasonography varies widely. Computed tomography (CT) is less operator dependent. AIM To compare the performance and cost of twice-a-year ultrasonography to once-a-year triple-phase-contrast CT for HCC screening in veterans. We hypothesised that CT detects smaller HCCs at lower overall cost. METHOD One hundred and sixty-three subjects with compensated cirrhosis were randomised to biannual ultrasonography or yearly CT. Twice-a-year alpha-feto protein testing was performed in all patients. Contingency table analysis using chi-squared tests was used to determine differences in sensitivity and specificity of screening arms, survival analysis with Kaplan-Meier method to determine cumulative cancer rates. Multivariate logistic regression models were used to examine predictive factors. RESULTS Hepatocellular cancer incidence rate was 6.6% per year. Nine HCCs were detected by ultrasonography and eight by CT. Sensitivity and specificity were 71.4% and 97.5%, respectively, for ultrasonography vs. 66.7% and 94.4%, respectively, for CT. Although 58.8% of screen-detected HCC were early stage (Barcelona Clinic Liver Cancer stage A), only 23.5% received potentially curative treatment despite all treatment options being available. HCC-related and overall mortality were 70.5% and 82.3%, respectively, in patients with screen-detected tumour. Overall costs were less for biannual ultrasonography than annual CT. CONCLUSIONS Biannual ultrasonography was marginally more sensitive and less costly for detection of early HCC compared with annual CT. Despite early detection, HCC-related mortality was high. These data support the use of biannual ultrasonography for HCC surveillance in a US patient population (NCT01350167).
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Affiliation(s)
- C Pocha
- Hepatitis C Resource Center, Minneapolis VA Health Care System, Minneapolis, MN 55417, USA.
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Young RS, Aldiwani M, Hakeem AR, Nair A, Guthrie A, Wyatt J, Treanor D, Morris-Stiff G, Jones RL, Prasad KR. Pre-liver transplant biopsy in hepatocellular carcinoma: a potential criterion for exclusion from transplantation? HPB (Oxford) 2013; 15:418-27. [PMID: 23458127 PMCID: PMC3664045 DOI: 10.1111/hpb.12008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND In cirrhotic patients with hepatocellular carcinoma (HCC), poor differentiation in pre-liver transplantation (LT) biopsy of the largest tumour is used as a criterion for exclusion from LT in some centres. The potential role of pre-LT biopsy at one centre was explored. METHODS A prospective database of patients undergoing orthotopic LT for radiologically diagnosed HCC at St James's University Hospital, Leeds during 2006-2011 was analysed. RESULTS A total of 60 predominantly male (85.0%) patients with viral hepatitis were identified. There were discrepancies between radiological and histopathological findings with respect to the number of tumours identified (in 27 patients, 45.0%) and their size (in 63 tumours, 64.3%). In four (6.7%) patients, the largest lesion, which would theoretically have been targeted for biopsy, was not the largest in the explant. Nine (31.0%) patients with multifocal HCC had tumours of differing grades. In two (6.9%) patients, the largest tumour was well differentiated, but smaller tumours in the explant were poorly differentiated. In one patient, the largest lesion was benign and smaller invasive tumours were confirmed histologically. CONCLUSIONS The need to optimize selection for LT in HCC remains. In the present series, the largest tumour was not always representative of overall tumour burden or biological aggression and its potential use to exclude patients from LT is questionable.
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Affiliation(s)
- Richard S Young
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Mohammed Aldiwani
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Abdul R Hakeem
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Amit Nair
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Ashley Guthrie
- Department of Radiology, St James's University HospitalLeeds, UK
| | - Judy Wyatt
- Department of Histology, St James's University HospitalLeeds, UK
| | - Darren Treanor
- Department of Histology, St James's University HospitalLeeds, UK
| | - Gareth Morris-Stiff
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK
| | - Rebecca L Jones
- Department of Hepatology, St James's University HospitalLeeds, UK
| | - K Rajendra Prasad
- Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University HospitalLeeds, UK,Correspondence K. Rajendra Prasad, Department of Transplant and Hepaticopancreaticobiliary Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Tel: + 44 113 206 5921. Fax: + 44 113 244 8182. E-mail:
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Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol 2012; 57:930-2. [PMID: 22739095 DOI: 10.1016/j.jhep.2012.04.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/09/2012] [Accepted: 04/11/2012] [Indexed: 12/14/2022]
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Sun C, Chen P, Chen Q, Sun L, Kang X, Qin X, Liu Y. Serum paraoxonase 1 heteroplasmon, a fucosylated, and sialylated glycoprotein in distinguishing early hepatocellular carcinoma from liver cirrhosis patients. Acta Biochim Biophys Sin (Shanghai) 2012; 44:765-73. [PMID: 22751611 DOI: 10.1093/abbs/gms055] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aberrant glycan structure of serum glycoproteins creates unique patterns in different stages of hepatocellular carcinoma (HCC), which provides potential glycan biomarkers for early diagnosis of HCC. In this study, tandem lectin affinity chromatography using aleuria aurantia lectin (AAL) and wheat germ agglutinin (WGA) was processed to purify both fucosylated and sialylated serum glycoproteins from 27 liver cirrhosis (LC) and 27 early HCC patients, in which 122 glycoproteins were finally screened out by liquid chromatography-tandem mass spectrometry (LC-MSMS). Among the 122 proteins identified by LC-MSMS, 8 of them were only identified in HCC serum and another 6 existed only in LC serum. Serum paraoxonase 1 (PON1) was immunoprecipitated from 47 individual patients and blotted by lectins, showing enhanced fucosylation and sialylation in HCC serum than those in LC serum. The area under the ROC curve (AUROC) for AAL-reactive PON1 was 0.892 with a sensitivity of 71.4% and a specificity of 94.7% in differentiating early HCC from LC. Similarly, WGA-reactive PON1 had an AUROC of 0.902 with a sensitivity of 95.2% and a specificity of 78.9%. The data indicated that the glycan differences of serum PON1 might serve as potential glycan biomarkers for distinguishing early HCC from LC patients.
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Affiliation(s)
- Chun Sun
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Müllhaupt B, Durand F, Roskams T, Dutkowski P, Heim M. Is tumor biopsy necessary? Liver Transpl 2011; 17 Suppl 2:S14-25. [PMID: 21744470 DOI: 10.1002/lt.22374] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center, Division of Gastroenterology and Hepatology, Zurich, Switzerland.
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Gómez Rodríguez R, Romero Gutiérrez M, González de Frutos C, de Artaza Varasa T, de la Cruz Perez G, Ciampi Dopazo JJ, Lanciego Pérez C, Gómez Moreno AZ. [Clinical characteristics, staging and treatment of patients with hepatocellular carcinoma in clinical practice. Prospective study of 136 patients]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:524-31. [PMID: 21940068 DOI: 10.1016/j.gastrohep.2011.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/05/2011] [Accepted: 06/07/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is the most frequent cause of mortality in patients with liver cirrhosis. There are no prospective series from a single tertiary hospital in Spain. MATERIAL AND METHODS We performed a prospective study of patients with HCC in our center. Clinical and epidemiological characteristics, diagnostic method, staging according to the Barcelona Clinic Liver Cancer (BCLC) system and treatment were analyzed. RESULTS A total of 136 patients were included (80.9% men). The mean age was 66.62 ± 11.68 years and 91.2% were cirrhotic. Hepatitis C virus (HCV) was the leading cause of liver disease (38.97%). The suspected diagnosis was established by a surveillance program in 63.2%. Noninvasive American Association criteria for the Study of Liver Diseases (AASLD) were the main diagnostic method (73.5%). According to the BCLC, 58.1% were in the early stage (0-A), 21.3% in stage B, 12.5% in stage C and 8.1% in stage D. Early stage patients had followed a surveillance program more frequently than those with non-early stages (79.75% versus 44.35%, p <0.001). Potentially curative initial treatment was used in 45.58%, the most common treatment being percutaneous ethanol injection (23.13%). CONCLUSIONS Most patients with HCC in our hospital have cirrhosis, the most frequent cause being HCV. HCC surveillance in at-risk patients could increase diagnosis of HCC at an early stage. We achieved an early diagnosis in more than half of cases. The most common initial treatment was percutaneous therapy.
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Kim KA, Kim MJ, Choi JY, Chung YE. Development of hepatocellular carcinomas in patients with absence of tumors on a prior ultrasound examination. Eur J Radiol 2011; 81:1450-4. [PMID: 21514759 DOI: 10.1016/j.ejrad.2011.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/15/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND To evaluate hepatocellular carcinoma (HCC) that developed in patients with no evidence of a tumor during a prior ultrasound (US) performed within 1 year of the diagnosis. METHODS We retrospectively analyzed data for 100 consecutive patients with liver cirrhosis who had undergone US within 1 year prior to HCC diagnosis and who showed no liver lesions on the previous US. Size and T stage of HCC were assessed as well as whether patients met surgical criteria for liver transplantation as HCC treatment [Milan or University of California at San Francisco (UCSF) criteria]. RESULTS The mean interval between the negative and diagnostic scans was 5 months, 13 days. HCC presented as a single nodule in 69 patients (size, 0.8-8.0 cm), as two or more nodules in 18 patients, and as the diffuse form of HCC in 13 patients. HCC presented as a small tumor (<3 cm) in 48 patients. T stages were: T1 in 26 patients, T2 in 45, T3 in 18, and T4 in 11. The Milan criteria were met in 79 patients. Eighty-five patients fulfilled the UCSF. CONCLUSION Patients may present with advanced HCC, even if sonographic findings were negative within 1 year prior to diagnosis.
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Affiliation(s)
- Kyung Ah Kim
- Department of Radiology, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea
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Kim TK, Lee KH, Jang HJ, Haider MA, Jacks LM, Menezes RJ, Park SH, Yazdi L, Sherman M, Khalili K. Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. Radiology 2011; 259:730-8. [PMID: 21364083 DOI: 10.1148/radiol.11101549] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To retrospectively identify magnetic resonance (MR) imaging findings that are associated with hepatocellular carcinoma (HCC) in 1-2-cm nodules detected at surveillance ultrasonography (US) and to propose newer MR imaging diagnostic criteria. MATERIALS AND METHODS Institutional research ethics board approval was obtained, and informed patient consent was waived. Among 145 consecutive patients who had 1-2-cm nodules that were newly detected at surveillance US, 108 patients underwent gadobenate dimeglumine-enhanced MR imaging. After excluding hemangiomas and unconfirmed nodules, the study sample comprised 96 patients with 116 nodules, including 43 HCCs and 73 benign nodules. MR imaging findings were assessed for signal intensity at each sequence. On the basis of the results of univariate and multivariable logistic regression analyses, several diagnostic criteria were developed by using combinations of MR imaging findings, which were then compared with the American Association for the Study of Liver Diseases (AASLD) practice guideline. RESULTS Univariate analysis revealed four imaging findings associated with HCC, including arterial phase hyperintensity, portal or delayed phase hypointensity (washout), hyperintensity on T2-weighted images, and hepatobiliary phase hypointensity (P < .001 for each). In the multivariable analysis, arterial phase hyperintensity (adjusted odds ratio [OR], 17.1; P = .003) and washout (adjusted OR, 11.7; P = .007) were associated with HCC. Of the developed criteria, the criteria including nodules fitting the AASLD practice guideline (arterial phase hyperintensity and washout) or nodules having three or more findings were considered most reasonable, showing improved sensitivity (77% [33 of 43] versus 67% [29 of 43], P = .048) and comparable specificity (95% [69 of 73] versus 99% [72 of 73], P = .09), as compared with AASLD practice guideline. CONCLUSION Alternative MR imaging criteria for diagnosing HCC in 1-2-cm nodules detected at surveillance US that can improve sensitivity compared with the AASLD practice guideline were proposed. A larger study is needed to verify the preliminary criteria in this study. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101549/-/DC1.
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Affiliation(s)
- Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2.
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Vilana R, Forner A, García Á, Ayuso C, Bru C. Carcinoma hepatocelular: diagnóstico, estadificación y estrategia terapéutica. RADIOLOGIA 2010; 52:385-98. [DOI: 10.1016/j.rx.2010.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/19/2010] [Accepted: 05/10/2010] [Indexed: 02/08/2023]
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Foschi FG, Dall'Aglio AC, Marano G, Lanzi A, Savini P, Piscaglia F, Serra C, Cursaro C, Bernardi M, Andreone P, Stefanini GF. Role of contrast-enhanced ultrasonography in primary hepatic lymphoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1353-1356. [PMID: 20733192 DOI: 10.7863/jum.2010.29.9.1353] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Ultrasonography is the first examination performed for screening of hepatocellular carcinoma (HCC); contrast-enhanced ultrasonography (CEUS) can help discriminate between HCC and other lesions. Primary hepatic lymphoma (PHL), even if rare, should be considered in the differential diagnosis of focal liver lesions (FLLs). Few data are available in the literature about the role of CEUS in the diagnosis of PHL; we tried to determine whether CEUS could have a role in this setting. METHODS we describe 2 cases of primary non-Hodgkin lymphoma of the liver associated with hepatitis B virus (HBV) infection. The first patient was a 62-year-old man who was an HBV-inactive carrier, and the second was a 58-year-old man with type 2 diabetes and chronic HBV hepatitis. RESULTS in both cases, ultrasonography showed a hypoechoic liver lesion (4 and 3 cm, respectively) with irregular margins in segment 4 of the liver. On CEUS, these lesions were inhomogeneously hyperenhanced in the arterial phase and hypoenhanced in the portal and late phases. Contrast-enhanced computed tomography (CT) in both patients showed slight hyperenhancement in the arterial phase and hypoenhancement in the remaining phases. Needle biopsy showed marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type in both patients. CONCLUSIONS Contrast-enhanced ultrasonography and CT did not help us differentiate PHL from HCC; in fact, in both cases we saw the characteristic findings of primary HCC. Primary hepatic lymphoma is a rare condition, but it should always be considered in the differential diagnosis of FLLs. We stress the important role of liver biopsy when imaging indicates HCC in patients without underlying cirrhosis.
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Piscaglia F, Lencioni R, Sagrini E, Pina CD, Cioni D, Vidili G, Bolondi L. Characterization of focal liver lesions with contrast-enhanced ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:531-550. [PMID: 20350680 DOI: 10.1016/j.ultrasmedbio.2010.01.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 12/08/2009] [Accepted: 01/15/2010] [Indexed: 05/29/2023]
Abstract
The introduction of second generation microbubble ultrasound (US) contrast agents, such as SonoVue (Bracco, Milan, Italy), has considerably improved the diagnostic yield of US imaging for the evaluation of focal hepatic lesions in recent years because of its ability to very sensitively depict tumoral vascularity. In addition, contrast-enhanced US (CEUS) has the advantage of the absence of ionizing radiation, the widespread availability, even at the bedside, and the possibility to characterize a lesion as soon as detected on conventional B-mode US, commonly used as the first technique for exploration of the liver. The present review focuses on the basic principles of the technique and the various patterns of benign and malignant hepatic lesions at CEUS, contributing to their characterization. Understanding of these enhancement features at CEUS according to the type of tumors enables to make more accurate characterization of focal liver lesions as well as give better advice to oncologists, hepatologists or other clinicians in case of suspected liver tumors.
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Affiliation(s)
- Fabio Piscaglia
- Division of Internal Medicine, Department of Clinical Medicine, University of Bologna, Bologna, Italy.
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Serum protein biomarkers screening in HCC patients with liver cirrhosis by ICAT-LC-MS/MS. J Cancer Res Clin Oncol 2010; 136:1151-9. [PMID: 20130913 DOI: 10.1007/s00432-010-0762-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 01/11/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prognosis of HCC remains poor mainly because of the lack of diagnosis biomarkers especially in patients with cirrhosis background. METHODS To identify serum biomarkers for HCC, we use cleavable stable isotope labeling (cICAT) combined with LC-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) to compare the serum proteome between liver cirrhosis and HCC patients. Sera from nine liver cirrhosis patients and nine HCC patients were selected for screening study. Then the alpha-1-acid glycoprotein (AGP) was chosen for validation by western blot. AGP was measured in the separate validation study including 52 HCC patients and 40 liver cirrhosis patients by rate nephelometry. Its value for HCC diagnosis from liver cirrhosis was also appreciated through receiver operating curve (ROC). RESULTS We quantified and identified 31 different proteins which include AGP, complement C4, haptoglobin, alpha-1-antitrypsin precursor, alpha-2-macroglobulin precursor, prothrombin precursor and ubiquitin carboxyl-terminal hydrolase 44 (USP44), etc. The serum concentration of AGP in HCC patients (n = 52) was significantly higher than in liver cirrhosis (n = 40) (P < 0.005) in validation study. AGP was useful for discrimination of the HCC cases from LC patients when the AFP levels were below 500 ng/ml. The area under curve (AUC) of the AGP and the combination of AGP and AFP were 0.834 (P < 0.0005, 95% CI: 0.734-0.934) and 0.880 (P < 0.0005, 95% CI, 0.789-0.970) separately, which are higher than AFP alone (0.538, P = 0.604, 95% CI: 0.386-0.689). CONCLUSION cICAT combined with LC-MS/MS-based serum proteome analysis can be useful in the screening of serum biomarkers for HCC. Alpha-1-acid glycoprotein combining AFP could aid the diagnosis of HCC.
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Vilana R, Forner A, García Á, Ayuso C, Bru C. Hepatocellular Carcinoma: Diagnosis, staging, and treatment strategy. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Andreana L, Isgrò G, Pleguezuelo M, Germani G, Burroughs AK. Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis. World J Hepatol 2009; 1:48-61. [PMID: 21160965 PMCID: PMC2998953 DOI: 10.4254/wjh.v1.i1.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/11/2009] [Accepted: 09/18/2009] [Indexed: 02/06/2023] Open
Abstract
Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multi-slice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.
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Affiliation(s)
- Lorenzo Andreana
- Lorenzo Andreana, Graziella Isgrò, Maria Pleguezuelo, Giacomo Germani, Andrew K Burroughs, The Royal Free Sheila Sherlock Liver Center, Departement of Surgery, Royal Free Hospital, London, NW3 2QG, United Kingdom
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SINGAL A, VOLK ML, WALJEE A, SALGIA R, HIGGINS P, ROGERS MAM, MARRERO JA. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30:37-47. [PMID: 19392863 PMCID: PMC6871653 DOI: 10.1111/j.1365-2036.2009.04014.x] [Citation(s) in RCA: 522] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A majority of studies investigating the accuracy of ultrasound for detecting hepatocellular carcinoma (HCC) do not reflect how this test is used for surveillance vs. diagnosis. AIM To determine the performance characteristics of surveillance with ultrasound for the detection of HCC, particularly early HCC as defined by the Milan criteria. METHODS A systematic literature review using the MEDLINE and SCOPUS databases yielded six studies that evaluated the accuracy of ultrasound for HCC at any stage and 13 studies that were specific to early HCC. RESULTS Surveillance ultrasound detected the majority of tumours before they presented clinically, with a pooled sensitivity of 94%. However, ultrasound was less effective for detecting early HCC with a sensitivity of 63%. Alpha-fetoprotein provided no additional benefit to ultrasound. Meta-regression analysis demonstrated a significantly higher sensitivity for early HCC with ultrasound every 6 months than with annual surveillance. Current studies have limitations such as verification bias and are of suboptimal quality. CONCLUSIONS Surveillance with ultrasound demonstrates limited sensitivity for early HCC, although this may be improved by testing at 6-month intervals. Currently available evidence evaluating surveillance ultrasound has significant limitations and future studies are necessary to determine optimal surveillance methods for early HCC.
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Affiliation(s)
- A. SINGAL
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - M. L. VOLK
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A. WALJEE
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - R. SALGIA
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - P. HIGGINS
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - M. A. M. ROGERS
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - J. A. MARRERO
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Jeng LB, Lo WY, Hsu WY, Lin WD, Lin CT, Lai CC, Tsai FJ. Analysis of urinary nucleosides as helper tumor markers in hepatocellular carcinoma diagnosis. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2009; 23:1543-1549. [PMID: 19399767 DOI: 10.1002/rcm.4034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hepatocellular carcinoma (HCC) is a common neoplasm in Taiwan, for which early diagnosis is difficult and the prognosis is usually poor. HCC is usually diagnosed by abdominal sonography and serum alpha-fetoprotein (AFP) detection. Modified nucleosides, regarded as indicators for the whole-body turnover of RNAs, are excreted in abnormal amounts in the urine of patients with malignancies and can serve as tumor markers. We analyzed the excretion patterns of urinary nucleosides from 25 HCC patients and 20 healthy volunteers by high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC/ESI-MS/MS) under optimized conditions. The HPLC/ESI-MS/MS approach with selective reaction monitoring (SRM) allowed for the sensitive determination of nucleosides in human urine samples. The mean levels of the urinary nucleosides adenosine, cytidine, and inosine were significantly higher in HCC patients than healthy volunteers (average of 1.78-, 2.26-, and 1.47-fold, respectively). However, the mean levels of urinary 1-methyladenosine, 3-methylcytidine, uridine, and 2'-deoxyguanosine were not significantly different. Combined with the determination of serum AFP levels, the higher levels of urinary adenosine, cytidine, and inosine may be additional diagnosis markers for HCC in Taiwanese patients.
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Affiliation(s)
- Long-Bin Jeng
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
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31
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Lu SN, Wang JH, Chen PF, Tung HD, Tseng PL, Hung CH, Kee KM, Chen CH, Chang KC, Lee CM, Changchien CS, Chen YD, Tsai LS, Chen THH. Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults. Cancer Epidemiol Biomarkers Prev 2008; 17:1813-21. [DOI: 10.1158/1055-9965.epi-07-2746] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Liu XE, Desmyter L, Gao CF, Laroy W, Dewaele S, Vanhooren V, Wang L, Zhuang H, Callewaert N, Libert C, Contreras R, Chen C. N-glycomic changes in hepatocellular carcinoma patients with liver cirrhosis induced by hepatitis B virus. Hepatology 2007; 46:1426-35. [PMID: 17683101 DOI: 10.1002/hep.21855] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED We evaluated the use of blood serum N-glycan fingerprinting as a tool for the diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis induced by hepatitis B virus (HBV). A group of 450 HBV-infected patients with liver fibrosis or cirrhosis with or without HCC were studied. HCC was diagnosed by alpha-fetoprotein (AFP) analysis, ultrasonography, and/or computed tomography and was studied histologically. N-glycan profiles of serum proteins were determined with DNA sequencer-based carbohydrate analytical profiling technology. In this study, we found that a branch alpha(1,3)-fucosylated triantennary glycan was more abundant in patients with HCC than in patients with cirrhosis, patients with fibrosis, and healthy blood donors, whereas a bisecting core alpha(1,6)-fucosylated biantennary glycan was elevated in patients with cirrhosis. The concentration of these 2 glycans and the log ratio of peak 9 to peak 7 (renamed the GlycoHCCTest) were associated with the tumor stage. Moreover, for screening patients with HCC from patients with cirrhosis, the overall sensitivity and specificity of the GlycoHCCTest were very similar to those of AFP. CONCLUSION This study indicates that a branch alpha(1,3)-fucosylated glycan is associated with the development of HCC. The serum N-glycan profile is a promising noninvasive method for detecting HCC in patients with cirrhosis and could be a valuable supplement to AFP in the diagnosis of HCC in HBV-infected patients with liver cirrhosis. Its use for the screening, follow-up, and management of patients with cirrhosis and HCC should be evaluated further.
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Affiliation(s)
- Xue-En Liu
- Department for Molecular Biomedical Research, Flanders Institute for Biotechnology, Ghent, Belgium
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Abstract
In Japan, hepatocellular carcinoma ranks as the fourth most common cancer and is responsible for about 40,000 deaths annually. Accordingly, the development of a screening system for its early detection will be linked to early treatment with a view to increasing survival. Algorithms for surveillance of hepatocellular carcinoma established in Japan will be useful for its early detection.
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Affiliation(s)
- Kiwamu Okita
- Social Insurance Shimonoseki Kohsei Hospital, Shimonoseki, Japan
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Trinchet JC, Ganne-Carrié N, Nahon P, N'kontchou G, Beaugrand M. Hepatocellular carcinoma in patients with hepatitis C virus-related chronic liver disease. World J Gastroenterol 2007; 13:2455-60. [PMID: 17552029 PMCID: PMC4146764 DOI: 10.3748/wjg.v13.i17.2455] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a major cause of hepatocellular carcinoma (HCC) worldwide due to the high prevalence of HCV infection and the high rate of HCC occurrence in patients with HCV cirrhosis. A striking increase in HCC incidence has been observed during the past decades in most industrialized countries, partly related to the growing number of patients infected by HCV. HCC is currently the main cause of death in patients with HCV-related cirrhosis, a fact that justifies screening as far as curative treatments apply only in patients with small tumors. As a whole, treatment options are similar in patients with cirrhosis whatever the cause. Chemoprevention could be also helpful in the near future. It is strongly suggested that antiviral treatment of HCV infection could prevent HCC occurrence, even in cirrhotic patients, mainly when a sustained virological response is obtained.
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Affiliation(s)
- Jean-Claude Trinchet
- Service d'Hépato-Gastroentérologie, Hôpital Jean Verdier, 93143 Bondy Cedex, France.
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35
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Taura K, Ikai I, Hatano E, Fujii H, Uyama N, Shimahara Y. Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old. Ann Surg 2006; 244:265-73. [PMID: 16858190 PMCID: PMC1602154 DOI: 10.1097/01.sla.0000217921.28563.55] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE By comparing cohorts in 2 exclusive time frames, the factors that affected the surgical outcomes of patients with hepatocellular carcinoma (HCC) are presented. SUMMARY BACKGROUND DATA Reportedly, survival results of patients with HCC who underwent hepatectomy have improved in recent years. However, the major factors contributing to these favorable outcomes have not been fully explained. METHODS Between January 1985 and December 2000, 610 patients with HCC underwent liver resections as a primary and curative resection. They were categorized into 2 groups according to the year in which the surgeries were performed: before 1990 (n = 212; early group); and after 1991 (n = 398; late group). Clinicopathologic data, survival data, type of recurrence, and treatment of intrahepatic recurrence were compared between the 2 groups. RESULTS Clinicopathologic data were almost identical between the groups except for age, blood loss, and duration of surgery. The overall survival rate was significantly better in the late group compared with the early group (58.0% vs. 39.1% at 5 years, P < 0.0001). By contrast, disease-free survival remained unchanged (27.8% vs. 26.2% at 5 years, P = 0.2887). The most common type of recurrence was intrahepatic relapse, and there was no difference in the rate and the type of recurrence between the 2 groups. The 5-year survival rate after recurrence was increased in the late group (21.8% vs. 11.6%, P = 0.0002). Stratified analysis by the type of initial recurrence revealed that better survival in the late group was achieved only in solitary intrahepatic recurrences, not in multiple intrahepatic or extrahepatic recurrences. Changes in modality of treatment of recurrence were observed only in the management of solitary intrahepatic recurrences, where percutaneous ablation therapies were more frequently applied with new ablation techniques. Patients that had undergone ablation therapies in the late group had better postrecurrent survival than those in the early group. Multivariate analysis showed that presence of local ablation therapies was an independent favorable prognostic factor only in the late group. CONCLUSIONS Significant improvements in outcomes were achieved in patients with HCC who underwent curative liver resections. Percutaneous ablation therapy for intrahepatic recurrence was considered to be a major contributory factor for improving survival after recurrence, as well as for overall survival.
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Affiliation(s)
- Kojiro Taura
- Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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36
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Trinchet JC, Ganne-Carrié N. [Should we screen for hepatocellular carcinoma?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:880-6. [PMID: 16885873 DOI: 10.1016/s0399-8320(06)73336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Jean-Claude Trinchet
- Hépato-Gastroentérologie, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, UFR SMBH-Université Paris 13, 93143 Bondy Cedex.
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Abstract
In patients with liver disease, thrombocytopenia is a clinical feature that may represent an obstacle to invasive diagnostic or therapeutic procedures, chemotherapy, and anti-viral treatment. Stimulation of the bone marrow is the most promising therapeutic intervention for thrombocytopenia in patients with chronic liver disease. The description of thrombopoietin and its (de)regulation in patients with chronic liver disease have disclosed new treatment opportunities. Indeed, pharmacologic treatment options for thrombocytopenia can be divided into treatments targeted at the thrombopoietin receptor (synthetic thrombopoietins and thrombopoietin-mimetic agents), and use of cytokines with general thrombopoietic potential. Unfortunately, use of synthetic thrombopoietin was hampered by the development of neutralizing antibodies, and thrombopoietin mimetic agents have not yet entered clinical studies. Interleukin-11 proved to be useful in increasing platelet count in patients with chronic liver disease, although its use is limited by side-effects. Erythropoietin has shown promising results in improving thrombocytopenia in cirrhotic patients. In patients with chronic liver disease, safe and well-tolerated treatments aimed at improving thrombocytopenia are still lacking. Larger studies are needed to evaluate and better characterize the thrombopoietic potential of erythropoietin. Human studies with thrombopoietin-mimetic agents are eagerly awaited in order to assess both effectiveness and safety of these drugs.
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Affiliation(s)
- E G Giannini
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy.
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38
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Colli A, Fraquelli M, Casazza G, Massironi S, Colucci A, Conte D, Duca P. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol 2006; 101:513-23. [PMID: 16542288 DOI: 10.1111/j.1572-0241.2006.00467.x] [Citation(s) in RCA: 364] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM In patients with chronic liver disease, the accuracy of ultrasound scan (US), spiral computed tomography (CT), magnetic resonance imaging (MRI), and alpha-fetoprotein (AFP) in diagnosing hepatocellular carcinoma (HCC) has never been systematically assessed, and present systematic review was aimed at this issue. METHODS Pertinent cross-sectional studies having as a reference standard pathological examinations of the explanted liver or resected segment(s), biopsies of focal lesion(s), and/or a period of follow-up, were identified using MEDLINE, EMBASE, Cochrane Library, and CancerLit. Pooled sensitivity, specificity, and likelihood ratios (LR) were calculated using the random effect model. Summary receiver operating characteristic (SROC) curve and predefined subgroup analyses were made when indicated. RESULTS The pooled estimates of the 14 US studies were 60% (95% CI 44-76) for sensitivity, 97% (95% CI 95-98) for specificity, 18 (95% CI 8-37) for LR+, and 0.5 (95% CI 0.4-0.6) for LR-; for the 10 CT studies sensitivity was 68% (95% CI 55-80), specificity 93% (95% CI 89-96), LR+ 6 (95% CI 3-12),and LR- 0.4 (95% CI 0.3-0.6); for the nine MRI studies sensitivity was 81% (95% CI 70-91), specificity 85% (95%CI 77-93), LR+ 3.9 (95%CI 2-7), and LR- 0.3 (95% CI 0.2-0.5). The sensitivity and specificity of AFP varied widely, and this could not be entirely attributed to the threshold effect of the different cutoff levels used. CONCLUSIONS US is highly specific but insufficiently sensitive to detect HCC in many cirrhotics or to support an effective surveillance program. The operative characteristics of CT are comparable, whereas MRI is more sensitive. High-quality prospective studies are needed to define the actual diagnostic role of AFP.
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Affiliation(s)
- Agostino Colli
- Department of Internal Medicine, Ospedale A. Manzoni, Lecco, Italy
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Lu SN, Wang JH, Liu SL, Hung CH, Chen CH, Tung HD, Chen TM, Huang WS, Lee CM, Chen CC, Changchien CS. Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high-risk for hepatocellular carcinoma. Cancer 2006; 107:2212-22. [PMID: 17019738 DOI: 10.1002/cncr.22242] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective of this study was to examine the usefulness of platelet counts in the diagnosis of cirrhosis and for identifying high-risk individuals in a community-based hepatocellular carcinoma (HCC) screening program. METHODS Pilot Study 1 determined the correlation between platelet counts and pathologic hepatic fibrosis scores among individuals with chronic hepatitis B virus (HBV) infection (n = 122 patients) and hepatitis C virus (HCV) infection (n = 244 patients). Pilot Study 2 investigated proportions of individuals with thrombocytopenia (<150 x 10(3)/mm(3)) among patients with HCC (n = 4042 patients). Pilot Study 3 demonstrated the correlation between platelet counts and ultrasonographic (US) parenchyma scores among anti-HCV-positive individuals (n = 75 patients). The core study was a 2-stage, community-based screening for HCC among residents age 40 years or older in townships with a high prevalence of anti-HCV (n = 4616 individuals) and in townships with a low prevalence of anti-HCV (n = 1694 individuals). Patients with thrombocytopenia were identified for US and alpha-fetoprotein screening. RESULTS Among the individuals who were positive for anti-HCV, platelet counts decreased according to increased pathologic fibrosis scores or US scores for liver parenchyma disease: The best cutoff platelet count was 150 x 10(3)/mm(3) for a diagnosis of cirrhosis. The sensitivity and specificity were 68.2% and 76.4%, respectively, for pathologic cirrhosis and 76.2% and 87.8%, respectively, for US cirrhosis. Forty-eight percent of patients with HCC were thrombocytopenic. The proportion of thrombocytopenia was significantly greater in patients with HCV-related HCC (63%) than in patients with HBV-related HCC (42%). In the townships with high and low anti-HCV prevalence, the prevalence of thrombocytopenia was 17.9% and 6.1%, respectively, (P < .001), respectively. Twenty-five patients were diagnosed with HCC, and all of those patients resided in the high-prevalence township. CONCLUSIONS Thrombocytopenia was a valid surrogate of cirrhosis and a valid marker for the identification of individuals at high-risk for HCC, especially in areas that had a high prevalence of HCV.
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Affiliation(s)
- Sheng-Nan Lu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Tisdale G, Mahadevan A, Matthews RH. T‐Cell Lymphoma of the Rectum in a Patient with AIDS and Hepatitis C: A Case Report and Discussion. Oncologist 2005; 10:292-8. [PMID: 15821249 DOI: 10.1634/theoncologist.10-4-292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary T-cell non-Hodgkin's lymphoma (NHL) occurring in the context of acquired immune deficiency syndrome (AIDS) is uncommon. Here, we report and discuss such a case presenting in the rectum, and review relevant literature. Although typical in some respects, the case is, in other ways, somewhat unusual for an AIDS-related NHL (ARL); ARL tends to be B cell and advanced stage and our case was T cell and stage IE. In addition, the patient suffered from concomitant cirrhosis related to hepatitis C. Chemotherapeutic options for ARL were limited early in the AIDS epidemic due to poor tolerability. Although this has largely been mitigated by the advent of highly active antiretroviral therapy, our patient eventually suffered complications of chemotherapy, apparently related more to his liver disease than to either his lymphoma or AIDS, that ultimately brought about his demise.
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Affiliation(s)
- Gus Tisdale
- Department of Medicine, Boston University and Boston Veterans Health Affairs Medical Centers, Boston, Massachusetts, USA
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Abstract
Hepatocellular carcinoma (HCC) is responsible for a large proportion of cancer deaths worldwide. HCC is frequently diagnosed after the development of clinical deterioration at which time survival is measured in months. Long-term survival requires detection of small tumors, often present in asymptomatic individuals, which may be more amenable to invasive therapeutic options. Surveillance of high-risk individuals for HCC is commonly performed using the serum marker alpha-fetoprotein (AFP) often in combination with ultrasonography. Various other serologic markers are currently being tested to help improve surveillance accuracy. Diagnosis of HCC often requires more sophisticated imaging modalities such as CT scan and MRI, which have multiphasic contrast enhancement capabilities. Serum AFP used alone can be helpful if levels are markedly elevated, which occurs in fewer than half of cases at time of diagnosis. Confirmation by liver biopsy can be performed under circumstances when the diagnosis of HCC remains unclear.
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Affiliation(s)
- Eldad S Bialecki
- Division of Gastroenterology and Hepatology, St Louis University Liver Center, St Louis University School of Medicine, USA
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42
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Fukuda H, Inokuti Y. Aspiration biopsy using new ceramic-coated stainless steel puncture needle. J Biomed Mater Res B Appl Biomater 2004; 71:392-7. [PMID: 15386495 DOI: 10.1002/jbm.b.30098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine the medical applicability of a newly developed ceramic-coated stainless steel puncture needle for performing liver biopsies. A ceramic coating was applied to a stainless steel needle using a high-density plasma coating technique. The collected specimen was dipped in 10% formalin, embedded in paraffin, sliced into 4 microm-thick sections, and stained with hematoxylin-eosin (HE). Tissue specimens were observed under a low vacuum of 664 Pa using an environmental scanning electron microscope (ESEM-2700). The surface of the tissue severed by the ceramic-coated needle was smoother than that by the stainless steel 21G ultrasonic biopsy needle according to microscopic image stained with HE, interference microscopic images, and ESEM images. In conclusion, damage to samples collected by the ceramic-coated needle is less than that by the ordinary needle.
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Affiliation(s)
- Hiroyuki Fukuda
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-shi, 260-0856, Japan.
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world, responsible for 500,000 deaths globally every year. Although HCC is a slow-growing tumor, it is often rapidly fatal because it is usually not discovered until the disease is advanced. HCC occurs primarily in individuals with cirrhosis, a condition that increases the risk of performing potentially curative surgical therapy. Over the last 2 decades, however, the safety of surgical resections has greatly improved because of advances in radiologic assessment, patient selection, and perioperative care. As such, the operative mortality rate for hepatectomy has decreased from the 10%-20% level seen in the 1980s to less than 5% today. The ultimate goal of treatment of HCC is to prolong the quality of life by eradicating the malignancy while preserving hepatic function. For treatment with a curative intent, the gold standard remains surgical resection, by either partial hepatectomy or total hepatectomy followed by liver transplantation. Resectability and choice of procedure depend on many factors, including baseline liver function, absence of extrahepatic metastases, size of residual liver, availability of resources including liver graft, and expertise of the surgical team. Patients without cirrhosis can tolerate extensive resections, and partial hepatectomy should be considered first. For Child class B and C patients with a small HCC, liver transplantation offers the best results, whereas partial liver resection is indicated in patients with well-compensated cirrhosis. Living donor liver transplantation should be considered using the same criteria as that used for cadaveric transplantation.
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Affiliation(s)
- Tae-Jin Song
- College of Medicine, Korea University, Seoul, South Korea
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44
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Abstract
The diagnosis of hepatocellular carcinoma (HCC) includes detection of the index lesion, staging of the lesion within the liver, and assessment for extrahepatic metastasis. HCC is a highly vascular neoplasm usually arising in a cirrhotic liver. Based on this concept, consensus criteria have been developed for the radiographic diagnosis of HCC. These include: (1) identification of a mass >2 cm in diameter in a cirrhotic liver in 2 imaging modalities, and (2) contrast enhancement on computed tomography, magnetic resonance, or angiography. A mass lesion within a cirrhotic liver in the presence of a serum alpha-fetoprotein level >400 ng/mL also is diagnostic. For lesions <2 cm in diameter, histological confirmation is required. Serum markers for the diagnosis of early HCC (<2 cm in diameter) have not been established. Staging HCC for metastases is insensitive and is based on conventional criteria (eg, pulmonary nodules, skeletal metastases, and lymphadenopathy). Additional diagnostic techniques based on cytological advances, genomics, and proteomics are needed for the diagnosis and staging of this highly malignant neoplasm.
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Affiliation(s)
- Jayant A Talwalkar
- William J. von Liebig Transplantation Center, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Daniele B, Bencivenga A, Megna AS, Tinessa V. Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma. Gastroenterology 2004; 127:S108-12. [PMID: 15508073 DOI: 10.1053/j.gastro.2004.09.023] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although there is no definitive evidence that hepatocellular carcinoma (HCC) screening in high-risk groups improves survival, many physicians screen high-risk populations with various strategies. alpha-fetoprotein (AFP) and liver ultrasonography (US) are the most widely used tools. AFP sensitivity and specificity depend on the cut-off value chosen. In cirrhotic patients, using a cut-off level of 20 ng/mL, sensitivity is only around 60% and positive predictive value ranges from 9% to 50%, depending on HCC prevalence. Sensitivity and specificity are much higher (94.1% and 99.9%, respectively) in hepatitis B carriers, but positive predictive value is only 5%. The performance of US as a screening tool varies widely depending on the experience of the examiner and the technology used. Recent studies generally indicate a 60% sensitivity or higher, a specificity greater than 90%, and a positive predictive value of 70%. The cost effectiveness of screening strategies using AFP, US, or both have been estimated retrospectively or using decision models. In general, HCC screening using both AFP and US appears to be of borderline cost effectiveness or not cost effective at all. Based on the estimated HCC doubling time, the recommended screening interval is 6 months, although a 1-year interval seems as effective. Currently, HCC screening with AFP only is not recommended except when US is either not available or of poor quality. US seems more efficient as a screening tool. Pathology assessment of liver explants in living-donor transplantation programs will provide more precise and reliable information regarding the value of AFP and US as HCC screening tools.
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Affiliation(s)
- Bruno Daniele
- Medical Oncology Unit, G. Rummo Hospital, via dell'Angelo 1, 82100 Benevento, Italy.
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Van Thiel DH, Yong S, Li SD, Kennedy M, Brems J. The development of de novo hepatocellular carcinoma in patients on a liver transplant list: frequency, size, and assessment of current screening methods. Liver Transpl 2004; 10:631-7. [PMID: 15108254 DOI: 10.1002/lt.20120] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic end stage liver disease is the most frequent indication for liver transplantation. Individuals with end stage cirrhosis, and therefore individuals on liver transplant lists, are at increased risk of developing a hepatic cancer. Those individuals on liver transplant lists also may represent the best group available for evaluating the current methods for screening and surveillance for the development of hepatic cancer as an examination of the explant liver provides a gold standard for tumor assessment. Assuming that only tumor free individuals were screened at the onset of this study, the data obtained enables one to determine the frequency of new hepatic cancers since listing and evaluate the positive and negative predictive values of each assessment method over the surveillance interval. All patients listed for liver transplantation with end stage chronic liver disease, who did not have a hepatoma at the time of transplant listing, were followed and assessed for the development of a hepatic cancer while on the waiting list. The screening techniques utilized included quarterly alpha fetoprotein (alpha FP) determinations and ultrasound (US) studies as well as semi-annual triple phase computed tomography (CT) scans of the liver. alpha FP failed to identify any cases of de novo hepatic cancer in patients waiting for a liver transplant. In contrast, US and especially CT scanning with intravenous contrast identified new hepatic masses. The later method, which identified early enhancing mass lesions, was the more valuable method at identifying masses that subsequently were shown by pathologic examination of the explant liver to be hepatic cancers. However, only 14 of 20 individuals found to have a de novo tumor were identified by this method. Once identified however, the treatments utilized for hepatic tumor ablation while waiting for a transplant appear to be effective with a mean of 57.8+/-8.3% necrosis of the treated masses being identified at the time of explant examination. In conclusion these data suggest that: 1. The development of a hepatocellular carcinoma (HCC) in an individual on a transplant list is not rare and occurs in as many as 20% of cases; 2. The most effective method for the detection of de novo HCC appears to be semi-annual triphasic CT scan with the identification of a new early enhancing lesion; and 3. Once recognized, the presence of the tumor enables the individual to move up on the waiting list as result of the additional model endstage liver disease (MELD) points allowed for individuals with HCCs.
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Affiliation(s)
- David H Van Thiel
- Department of Medicine, Section of Hepatology, Loyola University Medical Center, Stritch School of Medicine, Chicago, IL, USA.
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Abstract
Nearly three million persons in the United States are viremic with hepatitis C (HCV). Despite a decreasing incidence of HCV in this country, the prevalence of HCV-related chronic liver disease is increasing. Most infections in the United States are acquired by intravenous drug use. The chronicity rate of HCV is high, reaching 85% in some populations, and the risk of progression to advanced liver disease is as high as 20% within twenty years of infection. Host factors like alcohol use accelerate the rate of progression. The enzyme immunoassay is the preferred initial test for diagnosis; the third generation assay has greater than a 99% specificity in immunocompetent patients. Barring contraindications, the standard of care for treatment of chronic HCV has become pegylated interferon and ribavirin. With this therapy, the cure rate for treatment-naïve patients is about 55%, but rates are higher in certain groups. Common side effects of therapy include neuropsychiatric symptoms, influenza-like symptoms and hematological abnormalities.
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Affiliation(s)
- Brian L Pearlman
- Center for Hepatitis C, Atlanta Medical Center, Atlanta, GA 30312, USA.
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Yuen MF, Lai CL. Screening for hepatocellular carcinoma: survival benefit and cost-effectiveness. Ann Oncol 2004; 14:1463-7. [PMID: 14504044 DOI: 10.1093/annonc/mdg400] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prognosis for patients with hepatocellular carcinoma (HCC) is poor by the time they present with symptoms. This review examines the usefulness of screening programs from the perspectives of survival benefit and of cost-effectiveness. MATERIALS AND METHODS Articles were searched through Medline for screening, HCC, treatment and cost-effectiveness. RESULTS Both ultrasonography and alpha-fetoprotein testing have a low sensitivity for detecting HCC, although a combination of the two investigations can increase sensitivity. They remain the main screening methods because they are convenient, non-invasive and easily assessable. Though earlier studies fail to show improvement in patient management and survival by screening, more recent studies demonstrate that screening can increase the chance of curative treatment and, more importantly, improve survival even after the adjustment of lead-time bias. This is probably due to the improvement in medical treatment and technology. The cost per tumor detected for a region is inversely proportional to the tumor incidence of that region. CONCLUSIONS In countries with a low prevalence of HCC, screening for HCC is not cost-effective. But in countries with a high prevalence of HCC, especially when screening is directed at older patients with a high risk of HCC, screening programs for HCC become much more cost-effective.
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Affiliation(s)
- M-F Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Caturelli E, Ghittoni G, Roselli P, De Palo M, Anti M. Fine needle biopsy of focal liver lesions: the hepatologist's point of view. Liver Transpl 2004; 10:S26-9. [PMID: 14762835 DOI: 10.1002/lt.20037] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Eugenio Caturelli
- Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
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Affiliation(s)
- Luigi Bolondi
- Department of Internal Medicine and Gastroenterology, University of Bologna, Policlinico S. Orsola Malpighi, Via Albertoni 15, 40138 Bologna, Italy.
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