Hepatocellular carcinoma other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Other diagnostic studies for hepatocellular carcinoma include biopsy and hepatic venous pressure gradiant.

Other Diagnostic Studies

Liver Biopsy

The diagnosis of hepatocellular carcinoma is confirmed by percutaneous biopsy and histopathologic analysis. Percutaneous biopsy should only be performed when diagnostic imaging results are uncertain.

Hep Par 1 Antibody Stain Tissue microarray technology is uses to test Hep Par 1 antibody stain which is showing promising results in differential diagnosis of HCC.[8]

There is a 3% risk of tumor spread in the percutaneous needle path[10]

Transjugular liver biopsy:

The comparison table for diagnostic studies of choice for hepatocellular carcinoma:[11]

Diagnostic Test Sensitivity Specificity
Percutaneous Ultrasound guided liver biopsy 90% 91%
Percutaneous CT guided liver biopsy 92% 98%
Sequence of Diagnostic Studies

The core needle biopsy should be performed when:[12]

  • A positive hepatic leision is detected in the patient on imaging studies.
  • The patient has underlying risk factors i.e HBV infection,HCV infection or liver cirrhosis.

Diagnostic Criteria

Hepatic venous pressure gradient measurement

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References

  1. Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, Leandro G, Dhillon AP, Burroughs AK (2006). "Transjugular liver biopsy: how good is it for accurate histological interpretation?". Gut. 55 (12): 1789–94. doi:10.1136/gut.2005.090415. PMC 1856467. PMID 16636018.
  2. Hollerbach S, Reiser M, Topalidis T, König M, Schmiegel W (2003). "Diagnosis of hepatocellular carcinoma (HCC) in a high-risk patient by using transgastric EUS-guided fine-needle biopsy (EUS-FNA)". Z Gastroenterol. 41 (10): 995–8. doi:10.1055/s-2003-42920. PMID 14562197.
  3. Wang L, Geng J, Li J, Li T, Matsumori A, Chang Y, Lu F, Zhuang H (2011). "The biomarker N-terminal pro-brain natriuretic peptide and liver diseases". Clin Invest Med. 34 (1): E30–7. PMID 21291633.
  4. Schirmacher P, Fleig WE, Tannapfel A, Langner C, Dries V, Terracciano L, Denk H, Dienes HP (2004). "[Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)]". Pathologe (in German). 25 (5): 337–48. doi:10.1007/s00292-004-0692-7. PMID 15278290.
  5. Tannapfel A, Dienes HP, Lohse AW (2012). "The indications for liver biopsy". Dtsch Arztebl Int. 109 (27–28): 477–83. doi:10.3238/arztebl.2012.0477. PMC 3402072. PMID 22833761.
  6. 6.0 6.1 "Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia". Hepatology. 49 (2): 658–64. 2009. doi:10.1002/hep.22709. PMID 19177576.
  7. Karabork A, Kaygusuz G, Ekinci C (2010). "The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma". Pathol. Res. Pract. 206 (8): 572–7. doi:10.1016/j.prp.2010.03.004. PMID 20400233.
  8. Fan, Zhen; van de Rijn, Matt; Montgomery, Kelli; Rouse, Robert V. (2003). "Hep Par 1 Antibody Stain for the Differential Diagnosis of Hepatocellular Carcinoma: 676 Tumors Tested Using Tissue Microarrays and Conventional Tissue Sections". Modern Pathology. 16 (2): 137–144. doi:10.1097/01.MP.0000052103.13730.20. ISSN 0893-3952.
  9. Grant, A (1999). "Guidelines on the use of liver biopsy in clinical practice". Gut. 45 (Suppl 4): 1–11. PMID 10485854. The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.
  10. Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A (2012). "Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report". Lancet Oncol. 13 (1): e11–22. doi:10.1016/S1470-2045(11)70175-9. PMC 3417764. PMID 22047762.
  11. El-Serag HB, Marrero JA, Rudolph L, Reddy KR (2008). "Diagnosis and treatment of hepatocellular carcinoma". Gastroenterology. 134 (6): 1752–63. doi:10.1053/j.gastro.2008.02.090. PMID 18471552.
  12. Song DS, Bae SH (2012). "Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period". Clin Mol Hepatol. 18 (3): 258–67. doi:10.3350/cmh.2012.18.3.258. PMC 3467428. PMID 23091805.
  13. Di Tommaso L, Roncalli M (2017). "Tissue Biomarkers in Hepatocellular Tumors: Which, When, and How". Front Med (Lausanne). 4: 10. doi:10.3389/fmed.2017.00010. PMC 5322593. PMID 28280721.
  14. Boyer TD (2006). "Wedged hepatic vein pressure (WHVP): ready for prime time". Hepatology. 43 (3): 405–6. doi:10.1002/hep.21118. PMID 16496346.
  15. Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS (2009). "Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis". J. Hepatol. 50 (5): 923–8. doi:10.1016/j.jhep.2009.01.014. PMID 19303163.
  16. Chelliah ST, Keshava SN, Moses V, Surendrababu NR, Zachariah UG, Eapen C (2011). "Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques". Indian J Radiol Imaging. 21 (4): 291–3. doi:10.4103/0971-3026.90693. PMC 3249946. PMID 22223943.


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