|ECR 2013 / B-0231|
|Accuracy of contrast-enhanced imaging in the pretransplantation staging of hepatocellular carcinoma (HCC) and pathologic predictive factors of HCC recurrence after liver transplantation (LT)|
According to our results, contrast-enhanced imaging can be considered accurate in pretransplantation staging of HCC as a high radiologic-pathologic correlation was found in the detection of viable tumor and in the assessment of parameters such as number of nodules or diameter of the larger nodule, which are crucial for HCC staging.
The association between imaging and histopathology in the detection of viable tumor remained also when pretransplantation treatment and in particular TACE (p<0,001) and RITA (p=0,006) had been undertaken before LT. This result is remarkable as the presence of marginal recurred HCCs around previously treated nodules, especially lipiodolized nodules, is known to be one of the most common imaging pitfalls (6).
Accuracy of imaging techniques was 75,4%, with no substantial difference between MDCT (75,4%) and MRI (75,7%). Comparatively with previous studies which evaluated MDCT and dynamic MRI with extracellular contrast agents, imaging sensitivity was 81,6%, with a slight difference between MDCT (82,35%) and MRI (78,26%)(3-5).
In our population the tumor recurrence rate was 13,7%, which is similar to the rates observed in other studies with comparable follow-up period and in which Milan selection criteria were adopted (7).
Potential imaging and pathological predictive factors for HCC recurrence after LT have been previously investigated. The most important significant predictive factors included tumor size and vascular invasion, while the role of microsatellitosis, poor histological differentiation and number of nodules is still controversial (7-9). In our study, imaging and pathological features which were associated in univariate analysis with recurrence after LT were the presence of viable tumor, > 3 viable nodules , > 3 cm diameter of largest nodule, >5 cm overall viable tumor size, whereas other pathological predictive factors for recurrence were bilobar distribution, combined HCC-cholangiocarcinoma type, differentiation grade > 1, contact between tumor and hepatic capsule, micro- or macro-vascular invasion and microsatellitosis.
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