Coarse nodular US pattern in hepatic cirrhosis: risk for hepatocellular carcinoma.
OBJECTIVE
To determine the prevalence of the coarse nodular ultrasonographic (US) pattern and its prognostic importance in terms of hepatocellular carcinoma (HCC) risk in hepatic cirrhosis caused by hepatitis B virus (HBV); HBV with hepatitis D virus (HDV), formerly known as hepatitis delta virus; hepatitis C virus (HCV); and alcoholic cirrhosis (ALC) or primary biliary disease (primary biliary cirrhosis [PBC]).


METHODS
Four hundred two cases of hepatic cirrhosis caused by HBV (94 patients), HDV (100 patients), HCV (100 patients), ALC (63 patients), or PBC (45 patients) were retrospectively reviewed to identify the US pattern present at diagnosis and its possible association with the cause of the disease and subsequent development of HCC during a mean follow-up of 43.9 months +/- 29.9 (SD). Data were analyzed with the chi2, Fisher exact, and log-rank tests and with the Kaplan-Meier method (all two-tailed).


RESULTS
The coarse nodular pattern was found in a significantly higher percentage of patients with HDV-related cirrhosis (51%) compared with those with HBV (9%), HCV (9%), ALC (11%), or PBC (9%) (P <.001). This pattern was associated with a significantly increased risk for HCC in patients with cirrhosis and HBV-, HCV-, and ALC-related disease but not in those with HDV-related disease and PBC.


CONCLUSIONS
The coarse nodular pattern is more often seen in patients with HDV-related cirrhosis, and, in this setting (in contrast to HBV-, HCV-, and ALC-related cirrhosis, as well as in PBC), it does not represent an added risk factor for HCC.
Caturelli
Eugenio
E
Department of Anatomy and Histopathology, Gastroenterology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. e.caturelli@tiscalinet.it
Castellano
Luigi
L
Fusilli
Saverio
S
Palmentieri
Bruno
B
Niro
Grazia A
GA
del Vecchio-Blanco
Camillo
C
Andriulli
Angelo
A
de Sio
Ilario
I
D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D003699:Hepatitis D / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000821:virology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography