title: Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma?
abstract: OBJECTIVE
  Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 77 patients with cirrhosis, 42 (54.5%) of whom had HCC, were enrolled in this study during 2009-2011. The group included 46 (59.7%) men. The mean age of the sample was 65.2 years. The principle aetiology of disease was hepatitis C virus (HCV)-related cirrhosis (66.2%). Liver function was assessed according to Child-Pugh classification. In all patients liver stiffness (LS) was measured using FibroScan(®). The presence of portal hypertension was indirectly defined as: (i) oesophageal varices detectable on endoscopy; (ii) splenomegaly (increased diameter of the spleen to ≥ 12 cm), or (iii) a platelet count of <100,000 platelets/mm(3).
  
  
  RESULTS
  Median LS in all patients was 27.9 kPa. Portal hypertension was recorded as present in 37 patients (48.1%) and absent in 40 patients (51.9%). Median LS values in HCC patients with and without portal hypertension were 29.1 kPa and 19.6 kPa, respectively (r = 0.26, P < 0.04). Liver stiffness was used to implement the Barcelona Clinic Liver Cancer algorithm in decisions about treatment.
  
  
  CONCLUSIONS
  The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.
authors.affiliation: Unit of General Surgery, Policlinico-Vittorio Emanuele, University Hospital Complex, University of Catania, Catania, Italy. nino.fish@hotmail.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesce
authors.forename: Roberto
authors.initials: R
authors.lastname: Scilletta
authors.forename: Angela
authors.initials: A
authors.lastname: Branca
authors.forename: Luciano
authors.initials: L
authors.lastname: Nigro
authors.forename: Arturo
authors.initials: A
authors.lastname: Montineri
authors.forename: Licia
authors.initials: L
authors.lastname: Larocca
authors.forename: Filippo
authors.initials: F
authors.lastname: Fatuzzo
authors.forename: Marine
authors.initials: M
authors.lastname: Castaing
authors.forename: Stefano
authors.initials: S
authors.lastname: Puleo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy / Q000821:virology; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000473:pathology / Q000821:virology; D004945:Esophagoscopy; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy / Q000821:virology; D007558:Italy; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010976:Platelet Count; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013163:Splenomegaly / Q000473:pathology / Q000821:virology