title: Expanded Milan criteria on pathological examination after liver transplantation: analysis of preoperative data.
abstract: BACKGROUND
  We sought to evaluate the accuracy of imaging techniques related to the Milan criteria (MC) compared with the explant histology and the survival of these patients.
  
  
  METHODS
  Between 1997 and 2006, we selected 45 cirrhotic patients with hepatocellular carcinoma distributed into two groups according to explant histology: MC and Expanded Milan Criteria (EMC). Age, gender, preoperative imaging (ultrasound [US] and/or computed tomography [CT]), maximal tumor dimension, number of tumors, explanted histology, histology degree, alpha-fetoprotein (AFP) level and vascular invasion were compared among the patients to evaluate the value of these prognostic factors for survival after liver transplantation.
  
  
  RESULTS
  By histology 42.2% explants were identified as EMC. The mean AFP level was 204.5 ng/mL. Vascular invasion was detected in 31.5% of explants and 68.4% showed incidental tumors. The survival rates after 10 years were 47.4% whereas MC patients showed 57.77%. The mean AFP level among MC patients was 150.2 ng/mL with vascular invasion detected in 7.7% of explants, and 47.4% with incidental tumors. The overall sensitivity of the imaging techniques was 83.3% for CT and 75% for US. The specificity was 96% for CT and 80.1% for US.
  
  
  CONCLUSIONS
  Scan examinations in the preoperative evaluation underestimated about 42.2% of tumors. Those patients had vascular invasion but the survival after 10 years was similar between the ECM and MC groups.
authors.affiliation: Unit of Liver Transplantation, Hospital de Clínicas, State University of Campinas, São Paulo, Brazil. ilkaboin@yahoo.com
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: E M
authors.initials: EM
authors.lastname: Pracucho
authors.forename: M C
authors.initials: MC
authors.lastname: Rique
authors.forename: R R P
authors.initials: RR
authors.lastname: Reno
authors.forename: D B D
authors.initials: DB
authors.lastname: Robertoni
authors.forename: P V V T
authors.initials: PV
authors.lastname: Silva
authors.forename: E T
authors.initials: ET
authors.lastname: Rosim
authors.forename: A B
authors.initials: AB
authors.lastname: Soares
authors.forename: C A F
authors.initials: CA
authors.lastname: Escanhoela
authors.forename: M I
authors.initials: MI
authors.lastname: Leonardi
authors.forename: J R
authors.initials: JR
authors.lastname: Souza
authors.forename: L S
authors.initials: LS
authors.lastname: Leonardi
mesh_terms: D000328:Adult; D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins