Sonographic detection of hepatocellular carcinoma and dysplastic nodules in cirrhosis: correlation of pretransplantation sonography and liver explant pathology in 200 patients.
OBJECTIVE
The objective of this study was to determine the sensitivity and specificity of sonography as an aid in detecting hepatocellular carcinomas and dysplastic nodules using explantation correlation in patients with cirrhosis and no known hepatocellular carcinomas.


METHODS
The sonography reports of 200 patients with cirrhosis who underwent sonography and then underwent liver transplantation within 90 days were retrospectively reviewed for focal solid liver lesions. All focal solid masses detected on sonography were considered possible hepatocellular carcinomas. The sonographic findings were compared with thin-section explanted liver pathologic results.


RESULTS
Twenty-seven patients (13.5%) had hepatocellular carcinoma at explantation, including four patients with diffuse, multifocal tumors. Eight of the 39 lesions were detected on sonography for a patient sensitivity of 29.6% and a lesion sensitivity of 20.5%. Sonography revealed three (75%) of four hepatocellular carcinomas larger than 5 cm in diameter, one (50%) of two hepatocellular carcinomas with diameters of 3.1-5.0 cm, one (20%) of five hepatocellular carcinomas with diameters of 2.1-3.0 cm, three (13.6%) of 22 hepatocellular carcinomas with diameters of 1-2 cm, and no lesions with diameters smaller than 1 cm. Forty-two patients (21%) had a total of 126 dysplastic nodules including two patients with innumerable lesions. Sonography depicted only two dysplastic nodules, for a patient sensitivity of 4.8% and a lesion sensitivity of 1.6%. The overall specificity of sonography for either hepatocellular carcinomas or dysplastic nodules was 96%.


CONCLUSIONS
Sonography has low sensitivity but high specificity in revealing hepatocellular carcinomas and dysplastic nodules in patients with a cirrhotic liver requiring liver transplantation. In these patients, sonography should not be the sole imaging modality used for lesion detection before transplantation.
Bennett
Genevieve L
GL
Department of Abdominal Radiology, New York University Medical Center, 560 First Avenue, New York, NY 10016, USA.
Krinsky
Glenn A
GA
Abitbol
Roxanne J
RJ
Kim
Sue Y
SY
Theise
Neil D
ND
Teperman
Lewis W
LW
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D018608:Ultrasonography, Doppler