Perihepatic lymph nodes as markers of disease response in patients with hepatitis C-related liver disease: a prospective clinical evaluation.
OBJECTIVE
To assess the clinical feasibility of utilizing the presence of perihepatic lymphadenopathy, seen on ultrasound, as a marker of response to antiviral treatment in patients with hepatitis C virus (HCV)-related liver disease.


METHODS
Eighty-five patients with HCV-related liver disease [51 men and 34 women; mean age 47 years (range 26-67)] underwent liver biopsy and baseline ultrasound scans. Twenty-two of these patients were followed up longitudinally with 6-monthly ultrasound scans, whereas they were receiving anti-HCV eradication therapy with interferon and ribavirin. Perihepatic lymph nodes detected in the coeliac axis and peripancreatic region were noted, with the largest node size on maximal diameter recorded. The patients were subsequently assessed in the light of long-term virological response to treatment.


RESULTS
Perihepatic lymph nodes were detected in 26 of the 85 patients. Of the 22 patients followed up longitudinally, 11 responded to antiviral treatment, nine failed to respond and two did not complete a course of treatment. No significant difference was found between patients with detectable lymphadenopathy and those without according to age, sex, disease severity and genotype. There was a general reduction in size of lymph nodes in both responders and nonresponders to treatment, although this reduction was only significant in the responder group (P=0.003).


CONCLUSIONS
The presence of perihepatic lymphadenopathy when detected in patients with viral hepatitis can potentially serve as an indicator of response to treatment. However, as only 30-40% of patients have detectable lymphadenopathy, its clinical utility is limited.
Grier
Scott
S
Liver Unit, Division of Medicine A, St Mary's Hospital Campus, Imperial College London, London, UK.
Patel
Nayna
N
Kuo
Yu-Ting
YT
Cosgrove
David O
DO
Goldin
Robert C
RC
Thomas
Howard C
HC
Taylor-Robinson
Simon D
SD
Lim
Adrian K P
AK
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D016903:Drug Monitoring / Q000379:methods*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000821:virology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D019562:Viral Load
D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin; D007372:Interferons