Abstract
Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double-blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2cm) at histological evaluation. Statistical analysis showed that diameters ≤2cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma.
Highlights
Disease recurrence after hepatic resection (HR) for hepatocellular carcinoma (HCC) might be predicted by pathological findings such as differentiation degree, presence of satellites and the existence of vascular microinfiltration
(this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma
Our recent study [15] suggested that HCC recurrence is associated with HCC nodules presenting more aggressive biologic behavior and these patterns could be identified by the intraoperative ultrasound (IOUS) evaluation: IOUS remains as the best real-time imaging method for evaluation of HCC nodules during laparoscopic and open liver surgery In this prospective, double-blind study, we prospectively classified, for the first time to our knowledge, pattern combinations for each primary HCC nodule obtained by IOUS during HR
Summary
Disease recurrence after hepatic resection (HR) for hepatocellular carcinoma (HCC) might be predicted by pathological findings such as differentiation degree, presence of satellites and the existence of vascular microinfiltration. These features could allow patients to be shortlisted for liver transplantation without proven malignant disease [1,2,3]. We investigated whether these IOUS patterns correlate with both the presence of same histological patterns and differentiation grade of HCC on the histologic features of the primary resected tumor Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. Aim of the study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histologic features of the primary resected tumor
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