title: Diagnosis of small hepatocellular carcinoma--imaging diagnosis and significance of tumor biopsy.
abstract: OBJECTIVE
  To compare the effectiveness of different imaging modalities and the significance of tumor biopsy for diagnosing small hepatocellular carcinoma.
  
  
  METHODS
  Nodules (n = 352) with diameters of 30 mm or less newly detected by periodic ultrasonography and computed tomography in 234 patients with chronic liver disease were investigated with magnetic resonance imaging and digital subtraction angiography. These findings were compared with histologic findings. Histologic diagnoses were dysplastic nodule (n = 23), well-differentiated hepatocellular carcinoma (n = 163), moderately differentiated hepatocellular carcinoma (n = 159), and poorly differentiated hepatocellular carcinoma (n = 7). We compared three groups based on-diameters of 10, 11-20, and 21-30 mm. Nodules were diagnosed as hepatocellular carcinoma if they had hypervascular staining on digital subtraction angiography, hyperintensity on magnetic resonance T2-weighted images, arterial phase enhancement on enhanced magnetic resonance imaging, or low-high-low density on enhanced computed tomography.
  
  
  RESULTS
  Imaging alone was sufficient to diagnose hepatocellular carcinoma in 66.3% of the well-differentiated nodules and 91.6% of the moderately and poorly differentiated nodules (P < 0.001) The size of the nodule influenced the diagnosis of hepatocellular carcinoma by imaging alone in 65.5% (< or = 10 mm), 77.2% (11-20 mm), and 92.3% (21-30 mm) (< or = 10 vs. 21-30: P < 0.0001, 11-20 vs. 21-30: P < 0.0005). It was impossible to determine the degree of differentiation of the hepatocellular carcinoma by imaging alone.
  
  
  CONCLUSIONS
  The effectiveness of imaging for the diagnosis of hepatocellular carcinoma improved with decreasing differentiation and increasing diameter of the nodules. Tumor biopsy was required to make a histological accurate diagnosis.
authors.affiliation: First Department of Internal Medicine, Nagoya City University Medical School, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Japan 467-8601.
authors.forename: H
authors.initials: H
authors.lastname: Horigome
authors.forename: T
authors.initials: T
authors.lastname: Nomura
authors.forename: K
authors.initials: K
authors.lastname: Saso
authors.forename: T
authors.initials: T
authors.lastname: Joh
authors.forename: H
authors.initials: H
authors.lastname: Ohara
authors.forename: S
authors.initials: S
authors.lastname: Akita
authors.forename: S
authors.initials: S
authors.lastname: Sobue
authors.forename: Y
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Y
authors.initials: Y
authors.lastname: Kato
authors.forename: T
authors.initials: T
authors.lastname: Kanematsu
authors.forename: G
authors.initials: G
authors.lastname: Murasaki
authors.forename: M
authors.initials: M
authors.lastname: Itoh
mesh_terms: D015901:Angiography, Digital Subtraction; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed