New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm

Gut ◽  
2018 ◽  
Vol 67 (9) ◽  
pp. 1674-1682 ◽  
Author(s):  
Matteo Renzulli ◽  
Maurizio Biselli ◽  
Stefano Brocchi ◽  
Alessandro Granito ◽  
Francesco Vasuri ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Algorithm ◽  
High Grade ◽  
Mri Findings ◽  
Entire Study ◽  
Dysplastic Nodules ◽  
Early Hcc ◽  
Study Population ◽  
And Diffusion ◽  
Higher Sensitivity

ObjectiveMany improvements have been made in diagnosing hepatocellular carcinoma (HCC), but the radiological hallmarks of HCC have remained the same for many years. We prospectively evaluated the imaging criteria of HCC, early HCC and high-grade dysplastic nodules (HGDNs) in patients under surveillance for chronic liver disease, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and diffusion-weighted imaging.DesignOur study population included 420 nodules >1 cm in 228 patients. The MRI findings of each nodule were collected in all sequences/phases. The diagnosis of HCC was made according to the American Association for the Study of Liver Diseases (AASLD) criteria; all atypical nodules were diagnosed using histology.ResultsA classification and regression tree was developed using three MRI findings which were independently significant correlated variables for early HCC/HCC, and the best sequence of their application in a new diagnostic algorithm (hepatobiliary hypointensity, arterial hyperintensity and diffusion restriction) was suggested. This algorithm demonstrated, both in the entire study population and for nodules ≤2 cm, higher sensitivity (96% [95% CI 93.5% to 97.6%] and 96.6% [95% CI 93.9% to 98.5%], P<0.001, respectively) and slightly lower specificity (91.8% [95% CI 88.6% to 94.1%], P=0.063, and 92.7% [95% CI 88.9% to 95.4%], P=0.125, respectively) than those of the AASLD criteria. Our new diagnostic algorithm also showed a very high sensitivity (94.7%; 95% CI 92% to 96.6%) and specificity (99.3%; 95% CI 97.7% to 99.8%) in classifying HGDN.ConclusionOur new diagnostic algorithm demonstrated significantly higher sensitivity and comparable specificity than those of the AASLD imaging criteria for HCC in patients with cirrhosis evaluated using Gd-EOB-DTPA MRI, even for lesions ≤2 cm. Moreover, this diagnostic algorithm allowed evaluating other lesions which could arise in a cirrhotic liver, such as early HCC and HGDN.

scholarly journals RESULTS OF IMMUNOHISTOCHEMISTRY IN THE DIFFERENTIAL DIAGNOSIS OF EARLY HEPATOCELLULAR CARCINOMA AND NODULES WITH HIGH-GRADE DYSPLASIA IN PATIENTS WITH CIRRHOSIS

2021 ◽  
Vol 58 (1) ◽  
pp. 82-86
Author(s):  
Gabriela Perdomo CORAL ◽  
Fernanda BRANCO ◽  
Rosalva MEURER ◽  
Patrícia dos Santos MARCON ◽  
Paulo Roberto Ott FONTES ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Differential Diagnosis ◽  
Low Grade ◽  
Beta Catenin ◽  
High Grade ◽  
Dysplastic Nodule ◽  
Dysplastic Nodules ◽  
Morphological Criteria ◽  
Early Hcc ◽  
Sensitivity Specificity

ABSTRACT BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies OBJECTIVE: To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC. METHODS: Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant. RESULTS: One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%. CONCLUSION: Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.

Stromal morphological changes and immunophenotypic features of precancerous lesions and hepatocellular carcinoma

2019 ◽  
Vol 72 (4) ◽  
pp. 295-303
Author(s):  
Dingbao Chen ◽  
Zhao Li ◽  
Weihua Zhu ◽  
Qian Cheng ◽  
Qiujing Song ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Differential Diagnosis ◽  
Morphological Changes ◽  
Precancerous Lesions ◽  
High Grade ◽  
Stromal Invasion ◽  
Ductular Reaction ◽  
Hepatocellular Carcinomas ◽  
Dysplastic Nodules ◽  
Small Hcc

AimsTo evaluate stromal histopathological features and immunostaining expression for differential diagnosis of low- and high-grade dysplastic nodules (HGDN) to early and progressed hepatocellular carcinomas (eHCC, pHCC).MaterialsWe evaluated sinusoid capillarisation (SC), solitary artery (SA), ductular reaction (DR), stromal invasion and expression of six biomarkers (GPC3, HSP70, GS, CD34, CK19, EpCAM) in a series of 97 cases.ResultsStromal morphological changes, including SC, DR and SA, exhibited significant differences in differential diagnosis. In one indicator, SC had the best sensitivity (90.00%) and accuracy (85.42%), and SA had the best specificity at 88.89 %. In combinations, SC +and SA +were favourable and optimal. The immunoreactivity of GPC3, HSP70 and GS increased significantly in line with the stepwise progression of hepatocarcinogenesis.ConclusionsStromal histopathology features are useful for diagnosing HGDN, eHCC and small HCC. The immunostaining panel of GPC3, HSP70 and GS can also be supplementary.

Impact of large regenerative, low grade and high grade dysplastic nodules in hepatocellular carcinoma development

2003 ◽  
Vol 39 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Mauro Borzio ◽  
Silvia Fargion ◽  
Franco Borzio ◽  
Anna Ludovica Fracanzani ◽  
Anna Maria Croce ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Low Grade ◽  
High Grade ◽  
Dysplastic Nodules

scholarly journals Expression of CD34 in cirrhotic liver: Reliance to dedifferentiation

2010 ◽  
Vol 67 (6) ◽  
pp. 459-462 ◽  
Author(s):  
Jasmina Gligorijevic ◽  
Biljana Djordjevic ◽  
Aleksandar Petrovic ◽  
Aleksandra Radicevic ◽  
Simonida Stojanovic
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Tissue ◽  
Vascular Supply ◽  
Cirrhotic Liver ◽  
Low Grade ◽  
Dysplastic Nodules ◽  
Regenerative Nodules ◽  
Early Hcc ◽  
Statistical Program ◽  
Isolated Arteries

Background/Aim. The vascular supply of dysplastic nodules (DN) is altered compared with surrounding cirrhotic nodules. Dysplastic nodules contain unpaired arteries which are isolated arteries unaccompained by bille ducts. In adition, capillarization or neovascularization is evident on CD34 and CD31 staining. The investigation of angiogenic profile of regenerative, dysplastic and nodules of hepatocellular carcinoma aimed at assessing whether vascular profile is in reliance to the process of dedifferentiation of hepatocytes during the course of cirrhosis. Methods. Thirty four liver nodules from surgical biopsies of 12 patients previously undiagnosed to have cirrhosis, were classified as regenerative, dysplastic and small hepatocellular carcinomas (HCC). The investigation included 8 large regenerative nodules (LRN), 11 low grade dysplastic nodules (LGDN), 12 high grade dysplastic nodules (HGDN) and 3 early HCC. Serial sections of the nodules and surrounding cirrhotic liver tissue were immunostained against CD34. The vascular counting method was performed. The results were analysed using SPSS computer statistical program. Results. The number of capillary unites showed significant differences among nodular types, with the largest number of capillaries in hepatocellular carcinoma as well as strong reliance to dedifferentiation. Conclusion. There is a significant correlation of sinusoidal capillarization to dediferentiation of the liver tissue during the course of cirrhosis. From diagnostic view, capillary counting may be helpfull to distinguish dysplastic from nondysplastic nodules. The appearance of dysplastic nodules in nonselected surgical biopsies is frequent enough to challenge caution during the follow-up of cirrhotic patients.

Update on Precursor and Early Lesions of Hepatocellular Carcinomas

2011 ◽  
Vol 135 (6) ◽  
pp. 704-715 ◽  
Author(s):  
Young Nyun Park
Keyword(s):  
Large Cell ◽  
Small Cell ◽  
Small Hepatocellular Carcinoma ◽  
High Grade ◽  
Precursor Lesions ◽  
Adequate Treatment ◽  
Improve Patient Survival ◽  
Early Lesions ◽  
Dysplastic Nodules ◽  
Early Hcc

Abstract Context.—There is increasing evidence to support a multistep model of the process of human hepatocarcinogenesis. Precursor lesions are characterized by the appearance of dysplastic lesions in the form of microscopic dysplastic foci and macroscopic dysplastic nodules. There are 2 types of small hepatocellular carcinoma (HCC) (≤2 cm in diameter): (1) early HCC with an indistinct margin and (2) progressed HCC with a distinct margin. Pathologic diagnostic criteria for early HCC have recently been set up based on a consensus between Eastern and Western pathologists. Objective.—To review the nomenclature, pathology, and biomarkers of precursor and early lesions of HCC. Data Sources.—Literature review and illustrations from case materials were used. Conclusions.—Dysplastic foci are composed of large and small cell changes. Small cell change is considered to be a more advanced precursor lesion than large cell change, and large cell change is a rather heterogeneous lesion that may represent both reactive change and true dysplasia. Dysplastic nodules can be categorized as low or high grade according to the degree of atypia. High-grade dysplastic nodules have been reported to show molecular changes similar to HCC and have a high risk of malignant transformation. Early HCC, which may correspond to microinvasive carcinomas of other organs, is a well-differentiated HCC, and differential diagnosis between early HCC and high-grade dysplastic nodule is difficult. Identification of stromal invasion and application of a panel of markers (glypican-3, heat shock protein 70, and glutamine synthetase) is helpful for diagnosis of early HCC. Detection of precursor lesions of HCC is important in recognizing patients with higher risk of developing HCC, and diagnosis of early HCC can improve patient survival by allowing for early and adequate treatment.

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