Diagnosis Of Liver Metastases Research Articles

PCN155 COMPARISON OF CLINICAL AND ECONOMIC OUTCOMES OF GADOXETIC-ACID AND EXTRACELLULAR CONTRAST AGENT MAGNETIC RESONANCE IMAGING AND CONTRAST COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF LIVER METASTASIS

Liver metastasis is a common condition in cases of colon cancer. When liver metastasis occurs, patients have a high mortality risk. Patients need to get an early and accurate diagnosis for avoiding this risk. MRI with Gadoxetic-acid(GAX) or extracellular contrast agent(ECCM), or contrast CT(CCT) are used for the diagnosis of liver metastasis in Turkey. The aim of the study was to compare the clinical and economic outcomes of alternative imaging methods in diagnosis of liver metastasis.

Abstract P5-08-25: Body mass index and liver metastasis in women with invasive breast carcinoma

Abstract INTRODUCTION: Breast cancer is the most prevalent non-skin cancer in women worldwide. Women with metastatic breast cancer to the liver have poor outcomes compared to metastases to other sites, frequently develop resistance to available hormonal and chemotherapeutic agents, and have poor overall survival. Conflicting evidence exists regarding the association of body mass index (BMI) with progression free and overall survival in patients with metastatic breast cancer. METHODS: A single institution retrospective study of women with breast cancer metastasis to the liver was conducted. The pathology reports and medical records from 2011 to 2017 were searched to identify cases with biopsy proven liver metastases. Several factors were considered including breast cancer histologic type and stage at diagnosis; estrogen receptor, progesterone receptor, and HER2-neu amplification status of the initially diagnosed breast cancer as well as the metastatic disease; patient age and ethnicity; BMI (kg/m2) at time of metastasis and at initial diagnosis; and, outcome to include survival after liver metastasis diagnosis. RESULTS: In our population, the BMI ranged from 21.2 kg/m2 to 56.3 kg/m2 (mean 28.4 kg/m2). Eighteen patients (62%) were either overweight or obese. Twenty-one patients (72.4%) were deceased at the time of the study with an average survival of 659 days after liver metastasis diagnosis (Table 1). Patients with a BMI > 30 (obese) had a significantly lower (p <0.0005) mean survival than patients who were overweight (BMI 25.0 kg/m2 - 29.9 kg/m2). Patients who were overweight had a significantly lower mean survival than patients who had a normal BMI (18.5 kg/m2 -24.9 kg/m2). Five patients with liver metastases survived greater than 2000 days. The mean BMI of these five patients was 25.4 kg/m2. CONCLUSION: Obesity is a well-known cause of co-morbidities, and has been suggested to negatively impact the prognosis in breast cancer. In patients with liver metastases, our data suggests that an increased BMI is associated with decreased survival. This appears to be consistent in both ER positive and Her-2 positive patients (Table 1). This finding may be true regardless of the metastatic site. Further investigation on BMI and patients with metastatic disease to the liver and other organs are needed. We continue to collect data on patients with metastatic disease to the liver and other sites, including bone, to further validate our findings. Table 1: Mean overall survival in patients with liver metastasisTotalER+ Liver MetastasisHER2+ Liver MetastasisBMI kg/m2N (%)Mean Survival (days)*N (%)Mean Survival (days)*N (%)Mean Survival (days)*Underweight (<18.5)0NA0NA0NANormal (18.5-24.9)6 (28.6)923.85 (31.3)1085.42 (40)547.5Overweight (25.0-29.9)8 (38.1)753.54 (25)7080NAObese (> 30)7 (33.3)3237 (43.7)3233 (60)315NA: not applicable*p-values <0.0005 Citation Format: Cynthia Reyes Barron, Maricarmen Planas-Silva, David G Hicks, Bradley M Turner. Body mass index and liver metastasis in women with invasive breast carcinoma [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-25.

Percutaneous Radiofrequency Ablation for Metachronous Hepatic Metastases after Curative Resection of Pancreatic Adenocarcinoma

ObjectiveTo retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.Materials and MethodsBetween 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.ResultsTechnical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.ConclusionRFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.

Capabilities of &lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT in the differential diagnosis of colorectal liver metastases

Aim. To study the capabilities of &lt;sup&gt;18&lt;/sup&gt;F -FDG PET/CT in the differential diagnosis of colorectal liver metastases. Materials and methods . A retrospective analysis of &lt;sup&gt;18&lt;/sup&gt;F -FDG PET/CT data of 126 patients with colorectal cancer was carried out. The final diagnosis of colorectal cancer was established based on the analysis of morphological material obtained from the primary tumor. The metastatic or benign origins of the liver foci was confirmed by histological examination or by the results of radiation examination (dynamic observation). Sensitivity and specificity of this method were determined using ROC analysis using the SUV as a numerical classifier. Results . Colorectal liver metastases were detected in 51 (40.5%) patients. Advanced extrahepatic tumor process was detected in 25 (19.8%) cases. There were no progression in 50 (39.7%) patients. Benign tumors were detected in 22 patients with colorectal cancer: in 10 cases coupled with liver metastases, in 12 – without them. Totally 166 focal liver lesions were found: 125 (75.3%) metastases and 41 (24.7%) benign tumors. According to ROC analysis, sensitivity and specificity of &lt;sup&gt;18&lt;/sup&gt;F -FDG PET/CT with SUV ≥ 3.0 in the diagnosis of liver metastases were 84.8% and 97.6% respectively, the area under the ROC curve – 0.893 (95% CI 0.836–0.936 , p &lt; 0.0001), positive predictive value and negative predictive value were – 99.1% and 67.8%, respectively. Conclusion. &lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT is a highly informative imaging method in the differential diagnosis of colorectal liver metastases larger than 10 mm. The use of quantitative data processing with a threshold value SUV ≥ 3.0 allows to achieve high sensitivity and specificity of the method.

The role of MDCT and MRI in the diagnosis of focal liver diseases

Despite the great technical achievements in the field of tomographic examinations (CT, MRI), the problem of differentiation of focal liver lesions cannot always be solved only in a non-invasive way. At the same time, MRI with a hepatospecific agent, gadoxetic acid, can solve many problems, primarily related to the diagnosis of liver metastases and monitoring of nodules in cirrhotic liver. The aim. To show the advantages of MRI with hepatobiliary MRI contrast agents as the final phase of non-invasive diagnosis of focal liver lesions. Material and methods . Abstracts of 183 scientific articles (2010–2019) were selected in the PubMed information and analytical system for the keywords “focal liver lesion” and “gadoxetic acid”. Articles about special aspects of MRI examination or general information were excluded. 29 full-text articles were selected for analysis. Results . The analysis data are grouped in three categories as “diagnosis of liver metastases”, “diagnosis of HCC against the background of normal hepatic parenchyma”, “MRI diagnosis of HCC against the background of cirrhosis”. Conclusion. The main achievement of MRI diagnostics with gadoxetic acid is the differentiation of small focal liver lesions, including metastases, regenerative nodes, dysplastic nodes, and highly differentiated HCC. This allows you to increasingly avoid invasive methods in the diagnosis of focal liver lesions. Integrated MRI technologies (MRI-DVI and MRI with gadoxetic acid) are currently the most informative, safe and in demand. In MRI with hepatobiliary contrast agents, the intensity of the HCC signal in the hepatospecific phase is considered as an imaging tumor biomarker. Border small liver nodules are usually not hypervascular, they are hypointensive in the hepatospecific phase.

Predictors of Overall and Progression-Free Survival in Patients with Ocular Melanoma Metastatic to the Liver Undergoing Y90 Radioembolization.

To investigate predictors of overall survival (OS) and progression-free survival (PFS) in patients with ocular melanoma metastatic to the liver undergoing yttrium-90 (Y90) radioembolization, including the effect of concurrent immunotherapy. An IRB-approved retrospective review of 24 patients with ocular melanoma metastatic to the liver who underwent Y-90 treatment between June 2003 and January 2018 was performed. Data regarding patients' performance status at the time of Y90, intra-/extrahepatic tumor burden, and treatment response were evaluated. RECIST was used to determine objective tumor response. Kaplan-Meier analysis was used to calculate OS and PFS from the first Y90 therapy. Log-rank analysis was used to determine predictors of prolonged OS and PFS. Median OS from primary diagnosis and diagnosis of liver metastases was 66months (mo) and 26.3mo, respectively. Median OS for those who received immunotherapy within 3months of undergoing Y90 was prolonged at 26.0mo versus 9.5mo for others (p = 0.014). Median OS for patients with an ECOG performance status of 0 was prolonged at 26mo versus 5.5mo for others (p = 0.003). Median hepatic PFS was prolonged in patients treated with Y-90 on concurrent immunotherapy at 10.3mo versus 2.7mo for TARE only (p = 0.002). Patients with an ECOG performance status of 0 had prolonged PFS (p = 0.002). Concurrent immunotherapy and an ECOG performance status of 0 at the time of Y90 therapy appear to be predictors of prolonged OS and PFS in patients with ocular melanoma metastatic to the liver.

108P - Influence of liver metastasis locations on overall survival in patients with colorectal cancer

BackgroundAbout 70% of patients with colorectal cancer develop liver metastases (LM). Although colorectal cancer patients with resectable LM have a good prognosis, there is little data at the difference in the locations of LM. We investigated how the location of LM affects prognosis of colorectal cancer patients. MethodsThe medical records of 196 colorectal cancer patients with liver metastasis from January 2008 to December 2018 were analyzed retrospectively. We defined liver metastasis within a 3-cm-radius sphere centered on the bifurcation of portal vein by computed tomography as central LM (group C), and other LM outside the 3-cm-radius sphere as peripheral LM (group P). We investigated the relation between location of LM and prognosis by using the Kaplan-Meier method and log-rank test, and the relation between location of LM and resection by using the chi-square test. ResultsPatient characteristics were as follows: median age 68.4 (range 30-87), female/male 115/81, colon/rectal cancer 117/79, advanced/recurrent 150/46, respectively. The characteristics of liver metastasis were as follows: mean maximum tumor size 38 mm (3 - 200), tumor number single/multi 58/138, group C/P 84/112, respectively. Median overall survival (OS) was 31 months [95% confidence interval (CI), 25.5 to 36.5 months] from the date of first diagnosis of LM. We divided 196 patients into two groups ofgroup C (n = 84) and group P (n = 112) by location of LM. Resection rate of LM was 11.9% (group C) and 50.9% (group P). Median OS in group C and group P was 18 months (95% CI, 12.3 to 23.7 months) and 38 months (95% CI, 35.2 to 40.8 months), respectively (p < 0.001). Resection of LM was performed significantly more often in group P than in group C (p < 0.001). Furthermore, the patients with resectable LM had a good prognosis not only in group P (mean OS 135 months, 95% CI, 109.4 to 160.7 months) but also in group C (mean OS 82 months, 95% CI, 67.5 to 96.0 months). ConclusionsIt is suggested that the colorectal cancer patients with peripheral LM might have a better prognosis than the patients with central LM. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Meta-analysis of MRI for the diagnosis of liver metastasis in patients with pancreatic adenocarcinoma.

Determining if a given patient with primary pancreatic adenocarcinoma (PDA) has hepatic metastasis is important for treatment planning. Several previous studies reported on the diagnostic performance of MRI for liver metastasis in patients with PDA. But the reported data are quite variable. To systematically determine the diagnostic performance of MRI for liver metastasis in patients with PDA, including comparing it with computed tomography (CT). Systemic review and meta-analysis. In all, 457 patients from five eligible articles. Conventional MR sequences with or without contrast enhancement at 1.5T and 3T. Two reviewers independently performed the data extraction. The reviewers identified and reviewed the original articles reporting the diagnostic performance of MRI for liver metastases in patients with PDA, including those articles making comparisons with CT. Meta-analytic summary sensitivity and specificity were calculated on a per-patient basis using a bivariate random effects model. We compared the meta-analytic summary sensitivity and specificity between MRI and CT. The meta-analytic summary sensitivity and specificity were 85% (95% confidence interval [CI], 74-92%; I2 = 0%) and 98% (95% CI, 78-100%; I2 = 85%), respectively. In comparison with CT, MRI showed a higher sensitivity (85% vs. 75%) but similar specificity (98% vs. 94%). MRI had good overall diagnostic performance for liver metastasis in patients with PDA, with a higher sensitivity than CT. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1737-1744.

Clinical application of AFP, CCL2 and HP in the diagnosis of liver metastasis from colorectal cancer

Objective To compare the clinical value of alpha-fetoprotein (AFP), chemokine (C-C motif) ligand 2 (CCL2) and haptoglobin (HP) in the diagnosis of liver metastasis of colorectal cancer. Methods 256 patients with colorectal cancer in the 983rd Hospital of the Joint Service Support Force of PLAl from Jan. 2016 to Dec. 2018 and 92 healthy subjects (control group) were enrolled. The patients were grouped according to liver metastasis, including liver metastasis group (72 cases) and non-liver metastasis group (184 cases). The serum levels of AFP, CCL2 and HP in different groups were compared. The diagnostic values of AFP, CCL2 and HP in liver metastasis of colorectal cancer were analyzed by ROC curve. Results The serum concentrations of AFP, CCL2 and HP were increased in the control group, non-liver metastasis group and liver metastasis group in order, and the diffences between any two groups were statistically significant (all P 0.05). The difference in CEA between two experimental groups was not statistically significant (P>0.05). The results of diagnostic efficacy for colorectal cancer liver metastases showed that AFP+CCL2+HP had the highest sensitivity (93.05%), HP had the highest specificity (92.75%), CCL2+HP had the hightest Judden index (0.80), HP had the highest positive predictive rate (75.60%), and AFP+CCL2+HP had the hightest negative predictive rate (97.92%). Conclusions Early diagnosis and prevention of liver metastasis of colorectal cancer can improve the long-term survival rate of patients with colorectal cancer. HP, CCL2 and AFP have important clinical value in early diagnosis of liver metastasis of colorectal cancer. Key words: Colorectal neoplasms; Liver metastasis; Alpha-fetoprotein; Chemokine (C-C motif) ligand 2; Haptoglobin

The Disease-Free Interval Between Resection of Primary Colorectal Malignancy and the Detection of Hepatic Metastases Predicts Disease Recurrence But Not Overall Survival

IntroductionThe disease-free interval (DFI) between resection of primary colorectal cancer (CRC) and diagnosis of liver metastases is considered an important prognostic indicator; however, recent analyses in metastatic CRC found limited evidence to support this notion.ObjectiveThe current study aims to determine the prognostic value of the DFI in patients with resectable colorectal liver metastases (CRLM).MethodsPatients undergoing first surgical treatment of CRLM at three academic centers in The Netherlands were eligible for inclusion. The DFI was defined as the time between resection of CRC and detection of CRLM. Baseline characteristics and Kaplan–Meier survival estimates were stratified by DFI. Cox regression analyses were performed for overall (OS) and disease-free survival (DFS), with the DFI entered as a continuous measure using a restricted cubic spline function with three knots.ResultsIn total, 1374 patients were included. Patients with a shorter DFI more often had lymph node involvement of the primary, more frequently received neoadjuvant chemotherapy for CRLM, and had higher number of CRLM at diagnosis. The DFI significantly contributed to DFS prediction (p =0.002), but not for predicting OS (p =0.169). Point estimates of the hazard ratio (95% confidence interval) for a DFI of 0 versus 12 months and 0 versus 24 months were 1.284 (1.114–1.480) and 1.444 (1.180–1.766), respectively, for DFS, and 1.111 (0.928–1.330) and 1.202 (0.933–1.550), respectively, for OS.ConclusionThe DFI is of prognostic value for predicting disease recurrence following surgical treatment of CRLM, but not for predicting OS outcomes.

592 – Sequential Diagnosis of Liver Metastasis from Pancreatic Cancer Using Contrast-Enhanced Transabdominal Ultrasonography Following Endoscopic Ultrasonography in Comparison with Gd-Eob-Dtpa-Enhanced Mri

592 – Sequential Diagnosis of Liver Metastasis from Pancreatic Cancer Using Contrast-Enhanced Transabdominal Ultrasonography Following Endoscopic Ultrasonography in Comparison with Gd-Eob-Dtpa-Enhanced Mri

Is dual-phase C-arm CBCT sufficiently accurate for the diagnosis of colorectal cancer liver metastasis during liver intra-arterial treatment?

This study aimed to estimate the accuracy of dual-phase C-arm cone beam computed tomography (CBCT) for the detection of colorectal cancer liver metastases, as compared with multidetector computed tomography (MDCT). Between March 2014 and December 2016, 49 consecutive patients referred for intra-arterial treatment for colorectal cancer liver metastases were enrolled in a single-center observational study. All patients were examined with MDCT and with dual-phase C-arm cone beam computed tomography performed after iodine injection in the proper hepatic artery before intra-arterial treatment. Two blinded observers independently reviewed all examinations. Diagnostic accuracy was determined using both a six-cell matrix method and a "worst-case scenario." Readers identified at MDCT 264 colorectal liver metastases and 43 other liver lesions. The early and late arterial phase showed 240 and 277 liver lesions respectively. A certainty of the diagnosis was obtained in 63% and 85% at the early (EAP) and late arterial phase (LAP), respectively. Streak artifacts or liver segment truncation, or inadequate enhancement was responsible for the inability to see or to correctly adjudicate a lesion to a diagnosis in 27% and 15% of the cases at the EAP and LAP. The "worst-case scenario" yielded a Se and Sp of 58% and 51%, respectively, at EAP and 84% and 70%, respectively, at LAP. On CBCT, EAP showed limited accuracy. LAP provided the best tumor detectability. • The early arterial phase (EAP) yielded poor accuracy: Se = 58% and Sp = 51% (p < 0.0001). • The late arterial phase (LAP) phase yielded good accuracy: Se = 84% and Se = 70% (p = 0.02). • The probability of a correct diagnosis at the EAP was 60%.

Abstract No. 537 Transarterial yttrium-90 radioembolization treatment of pancreatic cancer patients with liver-dominant metastatic disease

The presence of liver metastasis in pancreatic cancer patients portends a very poor prognosis; the reported median overall survival (OS) is 2.8 months without treatment1 and 5.7 months with systemic therapy.2 The purpose of this study is to evaluate the safety and efficacy of transarterial hepatic radioembolization in pancreatic cancer patients with liver-dominant metastatic disease. From April 2010 to September 2017, 26 patients (10 male, 14 female, average age of 65.5, range: 44 – 83) with metastatic pancreatic adenocarcinoma to the liver were treated with yttrium-90 (Y90) glass microsphere radioembolization. 19 had extrahepatic disease at the time of radioembolization. Prior to radioembolization 8 patients had a pancreatectomy. All patients received systemic chemotherapy prior to Y90 embolization and 19 received systemic therapy after embolization. 2 patients had other liver-directed therapy prior to embolization and none had liver-directed therapy after. Retrospective review of medical records and imaging studies was performed to evaluate toxicities, treatment response, and overall survival. The median follow-up period from Y90 embolization was 13 months (range, 1 - 85 months). Median OS from Pancreatic adenocarcinoma diagnosis was 30.7 months (95% CI, 20.3- 41.1 months), from diagnosis of liver metastasis was 21.8 months (95% CI, 17.2 - 26.3 months), and from radioembolization treatment was 7.0 months (95% CI, 2.0 - 12.0 months). After treatment, 21 patients reported grade 1 and 2 clinical toxicities, and 24 patients had grade 1 and 2 biochemical toxicities. 7 patients experienced grade 3 toxicities, with 4 patients having grade 3 clinical toxicities and 6 patients having grade 3 biochemical toxicities. Imaging at 3 months after treatment demonstrates partial response in 1 patient, stable disease in 9 patients, and progression of disease in 12 patients by RECIST criteria. 4 patients had no follow-up imaging. Radioembolization is safe and led to promising overall survival in pancreatic cancer patients with liver-dominant metastatic disease.

Imaging Characteristics of Liver Metastases Overlooked at Contrast-Enhanced CT.

The purpose of this study was to evaluate the imaging characteristics of liver metastases overlooked at contrast-enhanced CT. The records of 746 patients with a diagnosis of liver metastases from colorectal, breast, gastric, or lung cancer between November 2010 and September 2017 were reviewed. Images were reviewed when liver metastases were first diagnosed, and images from prior contrast-enhanced CT examinations were checked if available. These lesions were classified into two groups: missed lesions (those missed on the prior images) and detected lesions (those correctly identified and invisible on the prior images or there were no prior images). Tumor size, contrast-to-noise ratio, location, presence of coexisting liver cysts and hepatic steatosis, and indications for examination were compared between the groups. The t test and Fisher exact test were used to analyze the imaging characteristics of previously overlooked lesions. The final analysis included 137 lesions, of which 68 were classified as missed. In univariate analysis, contrast-to-noise ratio was significantly lower in missed lesions (95% CI, 2.65 ± 0.24 vs 3.90 ± 0.23; p < 0.001). The proportion of subcapsular lesions (odds ratio, 3.44; p < 0.001), hepatic steatosis (odds ratio, 6.35; p = 0.007), and examination indication other than survey of malignant tumors (odds ratio, 9.07; p = 0.02) were significantly higher for missed lesions. Liver metastases without sufficient contrast enhancement, those in patients with hepatic steatosis, those in subcapsular locations, and those found at examinations for indications other than to assess for tumors were significantly more likely to be overlooked.

Abstract P5-12-15: Hepatic-metastatsis pattern as a prognositc marker in metastatic breast cancer

Abstract Background: Liver is the third most frequent site for breast cancer metastasis. Despite of relatively high frequency of liver metastasis and its poor prognosis (median survival between 14-16 months), little is known about clinical outcome and histologic features or molecular mechanisms. The aim of this study was to identify the prognostic factor of breast cancer with liver metastasis, including the hepatic metastasis pattern by imaging studies and pathologic feature. Methods: We reviewed medical record of breast cancer patients with hepatic metastasis diagnosed between January 2003 and June 2017. We classified spreading pattern of liver metastases detected by computed-tomography scan as following three types: mass-forming (longitudinal diameter of new hepatic lesion &amp;gt; 10mm, well-defined border for minimal 3 consecutive studies by CT scan), nodular (longitudinal diameter of any newly-noted hepatic lesion &amp;lt; 10mm or 10mm, well-defined border for minimal 3 consecutive studies by CT scan) and infiltration pattern (to spread with ill-defined border for minimal 3 consecutive studies by CT scan). The overall survival (OS) was defined as the period from the date of initial diagnosis of liver metastasis to the date of patient's death or last follow-up. Results : 115 of patients with initially metastatic breast cancer, and 42 patients with recurrent breast cancer after curative surgery were enrolled. 13% of total patients presented with only liver metastasis when they are initially diagnosed as the metastatic breast cancer. 19% of total patients presented with nodular or infiltration pattern. Median OS of the patients with mass-forming liver metastasis was 18.1 (95% CI: 6.8-29.5) months and in nodular distribution and diffuse infiltration pattern was 13.4 (95% CI: 78-18.9) months (p=0.001). To elucidate the role of hepatic-metastasis pattern as a prognostic marker, we performed the cox-regression analysis. The patients with nodular/infiltrative liver metastasis showed poorer prognosis (hazard ratio: 2.18, 95% CI: 1.23-3.86, p-value: 0.007) than patients with mass-forming liver metastases significantly. Other prognostic marker is the subtype of breast cancer. Either HER2-positive (hazard ratio: 2.88, 95% CI: 1.59-5.23, p-value: 0.001) or triple negative breast cancer patients (hazard ratio: 6.17, 95% CI : 2.57-14.8, p-value&amp;lt;0.001) showed poorer prognosis than hormone-receptor positive subtype. Conclusion: In the present study, the patients with mass-forming pattern of liver metastases hormone-receptor presentation showed favorable outcome in overall survival after liver metastases. Further studies are required for the different hepatic metastatic patterns and their mechanisms in metastatic breast cancer. Citation Format: Joung EK, Yang J-H, Lee J. Hepatic-metastatsis pattern as a prognositc marker in metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-15.

Diagnostic performance of [18F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis.

To systematically determine the diagnostic accuracy of 18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MRI) for the detection of liver metastases and evaluate the sources of heterogeneity in the reported results. PubMed and EMBASE databases were searched up until December 31, 2017, to identify original research studies reporting the diagnostic performance (Se and Sp) of PET/MRI for liver metastases, in comparison with PET/CT. Study quality was assessed using QUADAS-2. The summary Se and Sp of the studies were estimated using hierarchical modeling methods. To determine causes of study heterogeneity, the presence of a threshold effect was analyzed, and meta-regression analysis was performed. Of 546 articles screened, eight suitable articles were identified, with seven for per-lesion analysis, and four for per-patient analysis. The meta-analytic summary Se and Sp for per-patient-based analysis were 99.2% (95% CI, 31.4-100.0%, I2= 89.4%) and 98.6% (95% CI, 84.0-99.9%, I2= 0.0%), respectively, while for per-lesion-based analysis they were 95.4% (95% CI, 78.3-99.2%, I2= 99.7%) and 99.3% (95% CI, 93.8-99.9%, I2= 96.5%). PET/MRI showed higher Se (95.4% vs. 68.3%) and Sp (99.3% vs. 95.8%) than PET/CT. Meta-regression analysis showed five significant factors affecting study heterogeneity: study subject characteristics, study design, MRI technique (DWI, HBP after injection of liver-specific contrast media), imaging review method, and reference standard. The diagnostic accuracy of [18F]FDG-PET/MRI for liver metastasis was high overall, but substantial heterogeneity was found. Further randomized controlled studies or prospective studies are needed to investigate the role of PET/MRI in liver metastasis in comparison with PET/CT. • [ 18 F]FDG-PET/MRI has high meta-analytic Se and Sp for the diagnosis of liver metastasis. • PET/MRI using DWI and HBP images significantly increased diagnostic accuracy. • Study heterogeneity was associated with subject characteristics, study design, MRI technique, image review method, and reference standard.

Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study.

The purpose of this study was to evaluate the performance of systematic MRI with DWI for the detection of liver metastases (LM) in patients with potentially resectable pancreatic ductal carcinoma and normal liver findings at CT. Patients with potentially resectable pancreatic ductal carcinoma and a normal liver at CT were enrolled in a prospective multicenter study between March 2011 and July 2013 and underwent preoperative MRI. The reference standard was pathologic analysis of detected hepatic lesions. A total of 118 patients were enrolled. MRI depicted liver lesions that were not visible at CT in 16 patients. All lesions were visualized both with and without DWI. Lesions were LM in 12 (10.2%) patients and were confirmed in seven patients by preoperative biopsy, four by intraoperative frozen section, and one at 6-month follow-up evaluation after pancreatic resection. All but one liver metastatic lesion diagnosed with MRI were smaller than 10 mm. Four of 118 (3.4%) patients had a false-positive diagnosis of LM at MRI and remained LM free after a follow-up period of 24 months or longer. Three of 102 (2.9%) patients with normal MRI findings had subcapsular LM that were diagnosed intraoperatively. At follow-up, 99 of 118 (83.9%) patients were LM free after a mean of 24 months. The patient-based sensitivity of MRI for the detection of LM was 80.0% (95% CI, 51.9-95.7%); specificity, 96.1% (95% CI, 90.4-98.9%); positive predictive value, 75.0% (95% CI, 47.6-92.7%); and negative predictive value, 97.1% (95% CI, 91.6-99.4%). Compared with CT, preoperative MRI improves the detection of LM in patients with potentially resectable pancreatic ductal carcinoma and may change management and the rate of unnecessary laparotomy and pancreatectomy for 10% of patients.

Role of MicroRNA in the Diagnosis and Therapy of Hepatic Metastases from Colorectal Cancer.

Colorectal cancer is one of the most common malignancies in both genders and liver metastasis appear in more than 50% of patients with colorectal cancer, worsening its morbidity and mortality rates. The existing methods for the diagnosis and prognosis of colorectal cancer seem to be insufficient to predict its aggressiveness, leading to poor outcomes for the patient. MicroRNAs are small non-coding RNAs, which interact with mRNAs in a posttranscriptional stage, and have been found to be involved in pathogenesis of cancer and its metastases. Their utility in diagnosis of colorectal liver metastasis gains ground through serum or tissue examination. Several miRNAs are related to colorectal cancer and its liver metastasis. Some of them have oncogenic and other tumor suppressive role in the development of colorectal liver metastasis, while many of them have been proved to be correlated with the overall survival and prognosis of patients with colorectal cancer. The aim of the present review is to give a detailed account of the different miRNAs that have been described as playing a role in hepatic metastases from colorectal cancer, emphasizing their diagnostic, prognostic and therapeutic implications.

Liver surgery of breast cancer liver metastases: rapid surgical decision after diagnosis does not negatively impact long-term results

Introduction: Surgery could be indicated in selected patients with breast cancer liver metastases (BCLM) but accurate identification of candidates for surgery remains a challenge. We investigated if an observational period of time after the diagnosis of BCLM could improve the selection for surgery. Methods: We performed a retrospective analysis of 72 consecutive patients operated for BCLM between 2000 and 2015. Clinicopathologic and outcome data were compared between 2 groups: Early surgery (ES), including patients operated for BCLM ≤12 months after liver metastases (LM) diagnosis, and late surgery (LS), including patients operated >12 months after diagnosis. Results: Mean age was 48 years (28-74) at time of liver surgery. Median time between primary and LM diagnosis was 35 months (0-211) and median time between LM diagnosis and surgery was 12 months (0-134). Clinicopathologic characteristics were similar in ES (n=37) and LS (n=35) patients. In the whole population, 1, 3 and 5-years progression free (PFS) and overall (OS) survivals were respectively of 70%, 43%, 30% and 93%, 66%, 43%. In multivariate analysis, neither PFS nor OS differences were observed between ES and LS groups (PFS - HR=1,13 p=0,72 and OS - HR=1,06, p=0,85 for LS), only primary tumor estrogen receptor positivity had a positive impact for OS (HR=0,48 p=0,05). Conclusion: No difference in survival was observed between patients operated rapidly for BCLM as compared with patients operated after observational period, suggesting that it is not necessary to postpone the surgery in patients with resectable LM.

Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors.

Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs. We retrospectively analyzed clinical features of 29 patients (mean age 67.8years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017. All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively. Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.