Patients with ultrasonic coarse-nodular cirrhosis who are anti-hepatitis C virus-positive are at high risk for hepatocellular carcinoma.
BACKGROUND
The relationship between echosonographic patterns of patients with cirrhosis who are antihepatitis C virus (HCV)-positive, the DNA synthesis of hepatocytes, and the risk for HCC were studied.


METHODS
Thirty-eight patients with anti-C-100 antibody-positive and Child's grade A posthepatitic cirrhosis were studied. DNA synthesis activity was measured by a bromodeoxyuridine (BrdU, a thymidine analogue)-labeling index (LI), using the BrdU-anti-BrdU in vitro method, and the patients were followed prospectively by frequent liver ultrasonography for 3 years. The ultrasound patterns were classified into fine, coarse, and coarse-nodular (CN) patterns, and the reproducibility of the classification in practical use also was confirmed.


RESULTS
Of the 21 patients with high DNA synthesizing cirrhosis (BrdU LI > or = 1.5%), 10 (48%) showed coarse-nodular, 5 (24%) coarse, and 6 (29%) fine pattern in ultrasonography. Conversely, of the 17 patients with low DNA synthesizing LC (BrdU LI < 1.5%), only 1 (6%) showed coarse-nodular, 2 (12%) coarse, and 14 (82%) fine pattern. A significant relationship was found between the two groups of BrdU LI and ultrasound imaging patterns (P < 0.05). The incidence of CN pattern was significantly higher (P < 0.01) in the high DNA synthesizing group than in low DNA synthesizing group. Of the 11 patients with CN pattern by ultrasound imaging, 10 (91%) were in the high DNA synthesizing group, and 9 (82%) developed HCC during the follow-up period, compared with 3 of 7 (43%) with coarse, and only one of 20 (5%) with fine pattern developed HCC. The incidence of HCC was significantly higher (P < 0.01) in patients with a CN cirrhosis pattern than in those with a fine pattern.


CONCLUSIONS
In patients with cirrhosis who are anti-HCV-positive, the CN pattern by ultrasound imaging indicates increased DNA synthesis of hepatocytes and a high risk for developing HCC.
Tarao
K
K
Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan.
Hoshino
H
H
Shimizu
A
A
Ohkawa
S
S
Harada
M
M
Nakamura
Y
Y
Ito
Y
Y
Tamai
S
S
Okamoto
N
N
D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000382:microbiology; D002455:Cell Division; D002471:Cell Transformation, Neoplastic; D004247:DNA / Q000032:analysis; D005260:Female; D018936:Hepatitis C Antigens; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D008113:Liver Neoplasms / Q000209:etiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D012307:Risk Factors; D014463:Ultrasonography
D000956:Antigens, Viral; D018936:Hepatitis C Antigens; D004247:DNA