title: Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation.
abstract: Dynamic contrast imaging techniques are considered the standard of care for the radiological diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. However, the accuracy of radiological diagnosis depends largely on the degree of arterial hypervascularization, which increases with tumor size. Owing to the interplay and prognostic relevance of tumor vascularization and cell differentation, we asked ourselves whether tumor grade also affects the outcome of radiological diagnosis. Sixty-two HCCs (47 of which measured 1-2 cm) were consecutively detected in 59 patients with compensated cirrhosis under surveillance with ultrasound and confirmed by way of echo-guided biopsy and concurrent investigations with contrast-enhanced ultrasound (CE-US), computed tomography (CT), and gadolinium magnetic resonance imaging (MRI). Tumor cell differentiation was evaluated using Edmondson-Steiner criteria in liver cores of 0.9-5.0 cm (median 1.6 cm). Eighteen (29%) HCCs were grade I (1.5 cm), 28 (45%) were grade II (1.5 cm), 16 (26%) were grade III (1.8 cm), and none were grade IV. Contrast wash-in and wash-out were concurrently demonstrated in 21 (34%) tumors by way of CE-US, including three (16%) grade I and 18 (41%) grade II-III (P = 0.08); in 32 (52%) tumors by way of CT, including three (16%) grade I and 29 (66%) grade II-III (P = 0.0006); and 28 (47%) tumors by way of MRI, including three grade I (16%) and 25 (57%) grade II-III (P = 0.01). Among 1- to 2-cm tumors, the radiological diagnosis was achieved in two of 16 grade I and 17 of 31 grade II-III tumors (P = 0.006).
  
  
  CONCLUSIONS
  Tumor grade, a relevant predictor of disease severity, influences the accuracy of dynamic contrast techniques in the diagnosis of HCC.
authors.affiliation: 1st Division of Gastroenterology, Center for Liver Diseases, Milan, Italy. massimo.colombo@unimi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Iavarone
authors.forename: Angelo
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: Laura Virginia
authors.initials: LV
authors.lastname: Forzenigo
authors.forename: Sara
authors.initials: S
authors.lastname: Massironi
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Guido
authors.initials: G
authors.lastname: Ronchi
authors.forename: Piero
authors.initials: P
authors.lastname: Biondetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Roncalli
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002454:Cell Differentiation; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D006514:Hepatitis B Surface Antigens