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Liu X, Espin-Garcia O, Khalvati F, Namdar K, Fischer S, Haider MA, Jhaveri KS. Hepatocellular adenoma subtyping by qualitative MRI features and machine learning algorithm of integrated qualitative and quantitative features: a proof-of-concept study. Clin Radiol 2023:S0009-9260(23)00231-3. [PMID: 37365116 DOI: 10.1016/j.crad.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/23/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
AIM To evaluate hepatocellular adenoma (HCA) subtyping using qualitative magnetic resonance imaging (MRI) features and feasibility of differentiating HCA subtypes using machine learning (ML) of qualitative and quantitative MRI features with histopathology as the reference standard. MATERIALS AND METHODS This retrospective study included 39 histopathologically subtyped HCAs (13 hepatocyte nuclear factor (HNF)-1-alpha mutated [HHCA], 11 inflammatory [IHCA], one beta-catenin-mutated [BHCA], and 14 unclassified [UHCA]) in 36 patients. HCA subtyping by two blinded radiologists using the proposed schema of qualitative MRI features and using the random forest algorithm was compared against histopathology. For quantitative features, 1,409 radiomic features were extracted after segmentation and reduced to 10 principle components. Support vector machine and logistic regression was applied to assess HCA subtyping. RESULTS Qualitative MRI features with proposed flow chart yielded diagnostic accuracies of 87%, 82%, and 74% for HHCA, IHCA, and UHCA respectively. The ML algorithm based on qualitative MRI features showed AUCs (area under the receiver operating characteristic curve [ROC] curve) of 0.846, 0.642, and 0.766 for diagnosing HHCA, IHCA, and UHCA, respectively. Quantitative radiomic features from portal venous and hepatic venous phase MRI demonstrated AUCs of 0.83 and 0.82, with a sensitivity of 72% and a specificity of 85% in predicting HHCA subtype. CONCLUSIONS The proposed schema of integrated qualitative MRI features with ML algorithm provided high accuracy for HCA subtyping while quantitative radiomic features provide value for diagnosis of HHCA. The key qualitative MRI features for differentiating HCA subtypes were concordant between the radiologists and the ML algorithm. These approaches appear promising to better inform clinical management for patients with HCA.
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Affiliation(s)
- X Liu
- Joint Department of Medical Imaging, University Health Network, Sinai Health System, University of Toronto, 585 University Ave., Toronto, ON, M5G 2N2, Canada
| | - O Espin-Garcia
- Department of Biostatistics, Princess Margaret Centre, University Health Network and Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - F Khalvati
- Diagnostic Imaging, Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada; Department of Medical Imaging, Institute of Medical Science (IMS), University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - K Namdar
- The Hospital for Sick Children, Institute of Medical Science, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - S Fischer
- Laboratory Medicine Program, University Health Network, University of Toronto, Laboratory Medicine and Pathobiology, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - M A Haider
- Joint Department of Medical Imaging, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 585 University Ave., Toronto, ON, M5G 2N2, Canada
| | - K S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Sinai Health System, University of Toronto, 585 University Ave., Toronto, ON, M5G 2N2, Canada.
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Herman P, Fonseca GM, Kruger JAP, Jeismann VB, Coelho FF. Guidelines for the Treatment of Hepatocellular Adenoma in the Era of Molecular Biology: An Experience-Based Surgeons' Perspective. J Gastrointest Surg 2021; 25:1494-1502. [PMID: 32666496 DOI: 10.1007/s11605-020-04724-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatocellular adenoma (HA) is a rare benign liver tumor with increasing incidence affecting young women. In the last years, much has changed in diagnosis, classification, and treatment, due to the identification of different molecular subtypes. With the evolving knowledge, especially on molecular characteristics of the disease, we are far from a consensus of how to deal with such a multifaceted benign disease METHODS: In the last 20 years, we have treated 134 patients with HA with a mean age of 28 years, being 126 women. Fifty patients had a history of abdominal pain and 13 patients had an acute episode of pain due to rupture and bleeding. Until 2009, adenomas larger than 4 cm in diameter were resected, regardless of gender. From 2010 to 2016, only adenomas larger than 5 cm were referred for surgical treatment. Since 2016, resection was indicated in all female patients with non-steatotic adenomas larger than 5 cm and all adenomas in men. RESULTS AND DISCUSSION One hundred twenty-four patients were submitted to resection, being in 21 major resections. Since 2010, 74% of resections were done laparoscopically. Patients with ruptured adenomas were treated with transarterial embolization. Morbidity rate was 8.1% with no mortality. Authors discuss point-by-point all the aspects and presentations of the disease and the best approach. We proposed a therapeutic guideline based on the best available evidence and in our experience. CONCLUSIONS Due to the complexity of the disease, the treatment of HA is one the best examples of an individualized approach.
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Affiliation(s)
- Paulo Herman
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vagner Birk Jeismann
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Goonawardena J, Ratnayake C, Cheung KT, Fox A. Should bariatric surgery be offered for hepatocellular adenomas in obese patients? Surg Obes Relat Dis 2020; 16:2117-2124. [PMID: 32771427 DOI: 10.1016/j.soard.2020.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/04/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity and metabolic syndrome are increasingly recognized as risk factors for development of hepatocellular adenoma (HCA). The implications of weight loss on HCA regression has not been previously reviewed. OBJECTIVES To analyze the effects of surgical and nonsurgical weight loss on HCA. SETTING University Tertiary Hospital. METHODS Literature review of full-text articles from PubMed and Scopus on patients with HCA who underwent surgical or nonsurgical weight loss was performed. Only English language articles were included and editorial comments were excluded. Wilcoxon signed rank test was used for paired data analysis. Spearman correlation was used for correlation between percent excess weight loss (%EWL) and number and size of HCA lesions. RESULTS Out of 4 studies, 7 patients were included in this review, all of whom were female. The median preintervention body mass index was 41 kg/m2 compared with the postintervention body mass index of 28 kg/m2 (P = .002). The %EWL following intervention positively correlated to reduction in number of HCA lesions (%) postintervention, with a Spearman correlation of .78 (P = .04). Similarly, %EWL postintervention was positively correlated, though not statistically significant, to reduction in lesion size (%), with a Spearman correlation of .46 (P = .29). All patients who were candidates for liver resection preintervention based on lesion size > 5 cm avoided liver resection postintervention following surgical and nonsurgical weight loss. CONCLUSIONS Effective long-term weight loss by surgical and nonsurgical methods result in regression of HCAs. Weight loss could avoid major liver resections or decrease the morbidity associated with liver surgery. Bariatric surgery should be considered as an option for management of surgically challenging HCAs in carefully selected obese patients. Multicenter long-term trials, while adjusting for cofounding factors, are required to determine the effects of surgical compared with nonsurgical weight loss on maintenance of HCA regression.
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Affiliation(s)
| | - Chathri Ratnayake
- Department of Internal Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - King Tung Cheung
- Department of Internal Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - Adrian Fox
- Hepatobiliary Unit, Department of General Surgery, Eastern Health, Box Hill, Victoria, Australia; Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
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Carnevale A, Pellegrino F, Cossu A, Ierardi AM, Parenti GC, Carrafiello G, Giganti M. Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary. Med Oncol 2020; 37:31. [PMID: 32193648 PMCID: PMC7102179 DOI: 10.1007/s12032-020-01355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 12/31/2022]
Abstract
With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.
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Affiliation(s)
- Aldo Carnevale
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy
| | - Alberto Cossu
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Ospedale Civile Santa Maria Delle Croci, Ravenna, 48100, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.
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Laube B, Michaelsen S, Meischner V, Hartwig A, Epe B, Schwarz M. Classification or non-classification of substances with positive tumor findings in animal studies: Guidance by the German MAK commission. Regul Toxicol Pharmacol 2019; 108:104444. [PMID: 31433998 DOI: 10.1016/j.yrtph.2019.104444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
One of the important tasks of the German Senate Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area (known as the MAK Commission) is in the evaluation of a potential for carcinogenicity of hazardous substances at the workplace. Often, this evaluation is critically based on data on carcinogenic responses seen in animal studies and, if positive tumor responses have been observed, this will mostly lead to a classification of the substance under investigation into one of the classes for carcinogens. However, there are cases where it can be demonstrated with a very high degree of confidence that the tumor findings in the experimental animals are not relevant for humans at the workplace and, therefore, the MAK Commission will not classify the respective substance into one of the classes for carcinogens. This paper will summarize the general criteria used by the MAK Commission for the categorization into "carcinogen" and "non-carcinogen" and compare this procedure with those used by other national and international organizations.
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Affiliation(s)
- Britta Laube
- Scientific Secretariat of the Senate Commission on the Investigation of Health Hazards of Chemical Compounds in the Work Area (MAK Commission), Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Sandra Michaelsen
- Scientific Secretariat of the Senate Commission on the Investigation of Health Hazards of Chemical Compounds in the Work Area (MAK Commission), Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Veronika Meischner
- Scientific Secretariat of the Senate Commission on the Investigation of Health Hazards of Chemical Compounds in the Work Area (MAK Commission), Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Andrea Hartwig
- Food Chemistry and Toxicology, Institute of Applied Bioscience, Karlsruhe Institute of Technology (KIT), Adenauerring 20a, 76131, Karlsruhe, Germany
| | - Bernd Epe
- Institute of Pharmacy and Biochemistry, University of Mainz, Staudingerweg 5, D-55099, Mainz, Germany
| | - Michael Schwarz
- Dept. of Experimental and Clinical Pharmacology and Toxicology, Dept. Toxicology, Eberhard Karls University, Wilhelmstr. 56, 72074, Tübingen, Germany.
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Dioguardi Burgio M, Ronot M, Paulatto L, Terraz S, Vilgrain V, Brancatelli G. Avoiding Pitfalls in the Interpretation of Gadoxetic Acid–Enhanced Magnetic Resonance Imaging. Semin Ultrasound CT MR 2016; 37:561-572. [DOI: 10.1053/j.sult.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Margonis GA, Ejaz A, Spolverato G, Rastegar N, Anders R, Kamel IR, Pawlik TM. Benign solid tumors of the liver: management in the modern era. J Gastrointest Surg 2015; 19:1157-68. [PMID: 25560181 DOI: 10.1007/s11605-014-2723-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, there has been a growing interest in solid benign liver tumors as the understanding of the pathogenesis and molecular underpinning of these lesions continues to evolve. We herein provide an evidence-based review of benign solid liver tumors with particular emphasis on the diagnosis and management of such tumors. METHODS A search of all available literature on benign hepatic tumors through a search of the MEDLINE/PubMed electronic database was conducted. RESULTS New diagnostic and management protocols for benign liver tumors have emerged, as well as new insights into the molecular pathogenesis. In turn, these data have spawned a number of new studies seeking to correlate molecular, clinicopathological, and clinical outcomes for benign liver tumors. In addition, significant advances in surgical techniques and perioperative care have reduced the morbidity and mortality of liver surgery. Despite current data that supports conservative management for many patients with benign liver tumors, patients with severe preoperative symptomatic disease seem to benefit substantially from surgical treatment based on quality of life data. CONCLUSION Future studies should seek to further advance our understanding of the underlying pathogenesis and natural history of benign liver tumors in order to provide clinicians with evidence-based guidelines to optimize treatment of patients with these lesions.
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Affiliation(s)
- Georgios Antonios Margonis
- Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
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