G. KAVUKÇU, S. TAMSAL, F. YILMAZ, D. NART, M. ZEYTUNLU, M. KILIÇ

Hepatocellular carcinoma in cirrhotic liver: Accuracy of pretransplantation ultrasonography

Amaç: Karaciğer nakil adayı olan sirozlu hastalarda hepatosellüler karsinoma saptamada ultrasonografinin etkinliğinin araştırılması. Gereç ve Yöntem: Ortotopik karaciğer nakli uygulanan 495 hastanın nakil öncesi ultrasonografi bulguları fokal karaciğer lezyonu açısından geriye dönük değerlendirildi. Ultrasonografide saptanan tüm solid lezyonlar olası hepatosellüler karsinoma kabul edildi. Eksplant karaciğer materyalinde hepatosellüler karsinoma odaklarının varlığı ve sayısı nakil öncesi ultrasonografi bulguları ile karşılaştırıldı. Bulgular: Seksen sekiz (%17.8) olguda eksplant karaciğerde hepatosellüler karsinoma saptandı. Hepatosellüler karsinoma boyutları 1mm-11cm arasında değişiyordu. Nakil öncesi ultrasonografi ile bu olguların 58'inde karaciğerde fokal solid lezyon saptanmıştı. Ultrasonografide solid lezyon gözlenen 16 olguda, histopatolojik incelemede hepatosellüler karsinoma saptanmadı. Ultrasonografinin sirotik karaciğerde hepatosellüler karsinoma için duyarlılığı %66, özgüllüğü %96, pozitif öngörü değeri %78, negative öngörğü değeri %93bulundu. Sonuç: Sirotik karaciğerde ultrasonografinin hepatosellüler karsinoma saptamada duyarlılığı tümör boyutu ile ilişkilidir ve düşüktür. Bununla beraber, özgüllüğü yüksektir ve ultrasonografide saptanan tüm solid lezyonlar aksi ispatlanana kadar hepatosellüler karsinoma gibi kabul edilmelidir.

Sirotik karaciğerde HCC: Pretransplant ultrasonografinin tanısal doğruluğu

Aim: To assess the accuracy of ultrasonography in detecting hepatocellular carcinoma in patients with advanced cirrhosis undergoing liver transplantation. Materials and Methods: Four hundred ninety five patients, who underwent liver transplantation and had histopathologically proved liver cirrhosis, were included in the study. Reports of pretransplantation ultrasonography and histopathologic evaluation of the explanted liver were retrospectively reviewed and compared for the presence of hepatocellular carcinoma. Results: Hepatocellular carcinoma was detected in the explanted liver in 88 (17,8%) patients. The hepatomas ranged in size from 0.1 to 11cm. One or more solid focal lesions were reported in the pretransplant ultrasonography examination in 58 of these patients. In 16 patients, with a focal lesion reported in the pretransplant US examination, no hepatocellular carcinoma was detected in the histopathologic examination. The patient detection sensitivity of ultrasonography for hepatocellular carcinoma was 66%, specificity was 96%, the positive predictive value was 78% and negative predictive value was 93%. Conclusion: Sensitivity of utrasonography for hepatocellular carcinoma detection mostly depends on tumor size and is low in liver transplant candidates. On the other hand, the specificity is high and all solid lesions discovered with the ultrasonography should be considered hepatocellular carcinoma until proven otherwise.

PDF

___

1) Oka H, Kurioka N, Kim K, et al. Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis. Hepatology 1990;12:680-7.
2) Ebara M, Ohto M, Sugiura N, et al. Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients. J Gastroenterol Hepatol 1990;5:616-26.
3) Redvanly RD, Chezmar JL, Strauss RM, Galloway JR, Boyer TD, Bernardino ME. Malignant hepatic tumors: safety of highdose percutaneous ethanol ablation therapy. Radiology 1993;188:283-5.
4) Livraghi T, Meloni F, Di Stasi M, et al. Sustained complete responce and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology 2008;47(1) 82-95.
5) N’Kontchou G, Mahamoudi A, Aout M, E, et al. Radiofrequency ablation of hepatocellular carcinoma: Longterm results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 2009;50(5):1475-83.
6) Stuart K. Chemoembolization in the management of liver tumors. Oncologist 2003;8(5):425-37.
7) Trevisani F, De Notaris S, Rossi C, Bernardi M. Randomized control trials on chemoembolization for hepatocellular carcinoma. J Clin Gastroenterol 2001;32:383-9.
8) Pulvirenti A, Garbagnati F, Regalia E, et al. Experience with radiofrequency ablation of small hepatocellular carcinomas before liver transplantation. Transplant Proc 2001;33:1516-7.
9) Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693-9.
10) Regalia E, Coppa J, Pulvirenti A, et al. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience. Transplant Proc 2001;33(1-2):1442-4.
11) Takayasu K, Moriyama N, Muramatsu Y, et al. The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients. AJR Am J Roentgenol 1990;155:49-54.
12) Sherman M, Peltekian KM, Lee C. Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology 1995;22:432-8.
13) Chalasani N, Horlander JC Sr, Said A, et al. Screening for hepatocellular carcinoma in patients with advanced cirrhosis. Am J Gastroenterol 1999;94:2988-93.
14) Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33:1394-1403.
15) Gambarin-Gelwan M, Wolf DC, Shapiro R, Schwartz ME, Min AD. Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation. Am J Gastroenterol 2000;95:1535-8.
16) Teefey SA, Hildeboldt CC, Dehdashti F, et al. Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. Radiology 2003;226:533-42.
17) Solmi L, Primerano AM, Gandolfi L. Ultrasound follow up of patients at risk for hepatocelular carcinoma:results of a pospective study on 360 cases. Am J Gastroenterol 1996;91(6):1189-94.
18) Sangiovanni A, Del Ninno E, Fasani P, et al. Increase survival of cirrhotic patients with a hepatocelular carcinoma detected during surveillance. Gastroenterology 2004;126(4):1005-14.
19) Trevisani F, Santi V, Gramenzi A, et al. Surveillance for early diagnosis of hepatocellular carcinoma: is it effective in intermediate/advanced cirrhosis? Am J Gastroenterol 2007;102(11):2448-57.
20) Zoli M, Magalotti D, Bianchi G, et al. Efficacy of a surveillance program for early detection of hepatocellular carcinoma. Cancer 1996;78:977-85.
21) Fasani P, Sangiovanni A, De Fazio C, et al. High prevalence of multinodular hepatocellular carcinoma in patients with cirrhosis attributable to multiple risk factors. Hepatology 1999;29:1704-7.
22) Cottone M, Turri M, Caltagirone M, et al. Screening for hepatocellular carcinoma in patients with Child's A cirrhosis: an 8-year prospective study by ultrasound and alpha-fetoprotein. J Hepatol 1994;21:1029-34.
23) Miller WJ, Federle MP, Campbell WL. Diagnosis and staging of hepatocellular carcinoma: comparison of CT and sonography in 36 liver transplantation patients. AJR 1991;157:303-6.
24) Rizzi PM, Kane PA, Ryder SD, et al. Accuracy of radiology in detection of hepatocellular carcinoma before liver transplantation. Gastroenterology 1994;107:1425 -9.
25) Tanaka S, Kitamura T, Nakanishi K, et al. Effectiveness of periodic checkup by ultrasonography for the early diagnosis of hepatocellular carcinoma. Cancer 1990;66:2210-4.
26) Larcos G, Sorokopud H, Berry G, Farrell GC. Sonographic screening for hepatocellular carcinoma in patients with