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Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: The importance of tumor cell differentiation
Author(s) -
Iavarone Massimo,
Sangiovanni Angelo,
Forzenigo Laura Virginia,
Massironi Sara,
Fraquelli Mirella,
Aghemo Alessio,
Ronchi Guido,
Biondetti Piero,
Roncalli Massimo,
Colombo Massimo
Publication year - 2010
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.23903
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , radiology , ultrasound , magnetic resonance imaging , biopsy , radiological weapon , contrast enhanced ultrasound , nuclear medicine
Dynamic contrast imaging techniques are considered the standard of care for the radiological diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. However, the accuracy of radiological diagnosis depends largely on the degree of arterial hypervascularization, which increases with tumor size. Owing to the interplay and prognostic relevance of tumor vascularization and cell differentation, we asked ourselves whether tumor grade also affects the outcome of radiological diagnosis. Sixty‐two HCCs (47 of which measured 1‐2 cm) were consecutively detected in 59 patients with compensated cirrhosis under surveillance with ultrasound and confirmed by way of echo‐guided biopsy and concurrent investigations with contrast‐enhanced ultrasound (CE‐US), computed tomography (CT), and gadolinium magnetic resonance imaging (MRI). Tumor cell differentiation was evaluated using Edmondson‐Steiner criteria in liver cores of 0.9‐5.0 cm (median 1.6 cm). Eighteen (29%) HCCs were grade I (1.5 cm), 28 (45%) were grade II (1.5 cm), 16 (26%) were grade III (1.8 cm), and none were grade IV. Contrast wash‐in and wash‐out were concurrently demonstrated in 21 (34%) tumors by way of CE‐US, including three (16%) grade I and 18 (41%) grade II‐III ( P = 0.08); in 32 (52%) tumors by way of CT, including three (16%) grade I and 29 (66%) grade II‐III ( P = 0.0006); and 28 (47%) tumors by way of MRI, including three grade I (16%) and 25 (57%) grade II‐III ( P = 0.01). Among 1‐ to 2‐cm tumors, the radiological diagnosis was achieved in two of 16 grade I and 17of 31 grade II‐III tumors ( P = 0.006). Conclusion: Tumor grade, a relevant predictor of disease severity, influences the accuracy of dynamic contrast techniques in the diagnosis of HCC. H EPATOLOGY 2010