Mass Lesions In Liver Research Articles

Locoregional Treatments in Peritoneal Metastasis from Gastric Cancer

Background: Liver cancer is among the top five causes of cancer death globally. Hepatocellular Carcinoma (HCC) accounts for up to 90% of primary liver neoplasms in adults. The incidence of thyroid me-tastasis from HCC is rare and estimated from 0.8 to 12%. This report describes a 51-year-old man presenting with hypercalcemia and known metastatic HCC with new metastasis to the thyroid gland. Case Report: A 51-year-old male was admitted due to symptomatic hypercalcemia. His medical history included HCC with metastasis to the retroperitoneal lymph nodes diagnosed one year prior. Computed tomography revealed an enlarging liver mass, diffuse lymphadenopathy and many osseous lytic lesions. Ultrasound of the neck revealed abnormal right cervical lymph nodes and a heterogeneous mass replacing the right thyroid gland. Biopsy of the right cervical lymph node immunohistochemical stained positive for PAN-K, Glypican-3, HepPar1 and Anti-Arginase and negative for p40 and CEA-poly, supporting the diagnosis for metastatic HCC. His hospital course was complicated by dysphagia, spontaneous bacterial peritonitis and acute-on-chronic liver failure. Despite aggressive resuscitation, he continued to decline and ultimately pursued hospice care. Conclusion: This case illustrates the need to have a high index of suspicion for thyroid metastasis in HCC patients presenting with a new-onset cervical mass, dysphagia or hypercalcemia. Metastatic cancer to the thyroid gland is generally considered a poor prognostic factor, as seen in this case with the rapid decline. This case demonstrates an extremely rare presentation of HCC with metastasis to the thyroid gland.

A case of rapidly progressing sarcomatous intrahepatic cholangiocarcinoma with suddenly appearing lymph node metastasis

BackgroundThe sarcomatous variant of carcinoma is relatively rare in intrahepatic cholangiocarcinoma (ICC). Sarcomatous ICC (SICC) is associated with a poorer prognosis compared with ICC. SICC is rarely diagnosed before surgery due to non-descriptive findings; it progresses rapidly, resulting in miserable prognosis. Here, we report a case of rapidly progressing SICC that showed a clinically significant tumor growth rate.Case presentationA 77-year-old woman who had undergone ileocecal resection for cecal cancer 5 years previously was found to have elevated levels of the tumor marker carbohydrate antigen 19-9. Although an abdominal computed tomography (CT) scan did not detect any liver mass lesions until 3 months before this serum examination, the subsequent CT scan revealed a hypodensity 20 mm mass lesion in the right anterior section. Contrast-enhanced CT and magnetic resonance imaging revealed peripheral enhancement in the arterial-to-equilibrium phase. Fluorodeoxyglucose positron emission tomography revealed uptake in the lesion. None of the imaging modalities showed lymph node swelling or distant metastases. She underwent hepatectomy under the diagnosis of ICC or an atypical metastasis from previous cecal cancer. Although preoperative images showed no suspicious lymph node metastasis 3 weeks prior, the hilar lymph node swelled 3 cm and contained adenocarcinoma. Consequently, the patient underwent right anterior sectionectomy and lymph node dissection of the hepatoduodenal ligament. Histopathological examination revealed that the liver tumor was a poorly differentiated adenocarcinoma with sarcomatous pattern. While the patient received adjuvant gemcitabine and S-1 therapy, lymph node metastasis appeared in the mediastinum 13 months after the surgery. She received gemcitabine + cisplatin + S-1 therapy but died 20 months after surgery.ConclusionSICC and lymph node metastasis clinically appeared within 3 months and 3 weeks, respectively. Suspected ICC that rapidly progresses should be considered SICC and treated with early resection. SICC is often missed in clinical diagnosis and has a poor prognosis, even after curative resection. While an alternative strategy involving preoperative biopsy and neoadjuvant therapy may be beneficial, it should be approached with discretion due to the potential risks of tumor progression and peritoneal dissemination.

Evaluation of Low-contrast Detectability Using the Digital Phantom Creation Tool in the Late Arterial Phase to Detect Liver Mass Lesions

Late arterial phase images of SD 8, SD 10, and SD 12 were acquired in the 3-phase dynamic study of the liver in combination with hybrid iterative reconstruction. We evaluated the low-contrast detectability by adding a simulated tumor to these images and aimed to formulate a standard image quality. We prepared images with and without signal for 60 series of 20 samples, each with 3 image quality types (total: 120 series). The continuous confidence method by 10 observers detected 60 simulated tumors. The detection sensitivities were 0.765, 0.785, and 0.260 for SD 8, SD 10, and SD 12, respectively (p<0.001) with no significantly different specificities, and the areas under the curve were 0.901, 0.892, and 0.616 (p<0.001), respectively. The simulated mass detection rates were 74.5%, 75.0%, and 21.5% for SD 8, SD 10, and SD 12, respectively (p<0.001), and the intraclass correlation coefficients, which indicate interobserver reliability, were 0.697 at SD 10 without signal, and SD 12 without a signal significantly dropped to 0.185. Therefore, SD 12 images increase the possibility of overlooking lesions. Hence, image quality in the late arterial phase should be SD 10 or less.

Image guided fine needle aspiration cytology of hepatic lesions – Two year study in a Tertiary health care centre, Telangana (Hyderabad)

Mass lesions of liver are generally evaluated by Fine needle aspiration (FNA). Aim of present study was to assess the utility of ultrasound guided FNA cytology in the diagnosis of hepatic lesions and to study the cytomorphological features of these lesions and to categorise them as inflammatory, benign and malignantPatients who have been admitted during a period between 2018 to 2021 February with suspected liver diseases were subjected to ultrasound guided FNAC and cytological assessment.Fine needle aspirations of liver were performed on 39 patients. Out of which 26 were suspected by malignant lesions and 13 of non-neoplastic lesions. Of the 39 aspirations performed on patients with suspected malignancy, 26 were diagnosed as positive (66.66%). Among other 13 non- neoplastic lesions only 6 were diagnosed positive under cytological examination by FNAC (46.15%). This could be due to more yield of material in malignant lesions than non-neoplastic lesions of liver and technical expertise of FNAIn most of the cases Cytomorphological study of Hepatic masses by fine needle aspiration yields an accurate diagnosis but in some cases correlation with other investigations and ancillary studies are required for definitive diagnosis.

Comparative Evaluation of Echinococcus Serology with Cytology for the Diagnosis of Hepatic Hydatid Disease.

Objectives The purpose of this study is to determine the diagnostic efficacy of enzyme-linked immunosorbent assay (ELISA) in radiologically confirmed liver mass lesions for the diagnosis of hepatic hydatid disease (HHD) and to compare the diagnostic performance of ELISA with fine needle aspiration cytology (FNAC) (taken as standard) for HHD diagnosis. Materials and Methods This retrospective study included blood samples of 223 patients with radiologically confirmed liver mass lesions in which immunoglobulin G (IgG) anti- Echinococcus antibodies were tested using a commercial IgG ELISA (RIDASCREEN, R-Biopharm AG, Darmstadt, Germany). Results of ELISA, ultrasonography, FNAC, and liver function tests were obtained from the hospital information system. ELISA results were compared with those of FNAC to analyze the diagnostic efficacy of ELISA for HHD diagnosis. Statistical Analysis Comparison of the results obtained from ELISA was performed with respect to FNAC results (taken as standard) to analyze the diagnostic efficacy of ELISA for HHD detection. Data has been represented as median (range) or in frequencies. Wilson score was used to assess 95% confidence interval of diagnostic parameters. The analysis was performed using SPSS Version 22.0 (IBM Corp.) and Open Epi (version 3.01). Results Out of 223 cases with liver mass lesions, Echinococcus IgG was reactive in 62 (28%) cases and FNAC was positive in 16 (7.2%) cases. Since two cases were FNAC-positive but IgG-nonreactive, total HHD cases were 64 (28.7%). Echinococcus IgG reactive cases were seen more in the extremes of age group, that is, 1 to 10 years and 81 to 90 years. Taking FNAC as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ELISA were 87.5, 76.8, 22.6, and 98.7%, respectively. Cytology-positive cases demonstrated a mean ELISA optical density/cut-off (OD/CO) of 4.2 ± 3 standard deviation. Conclusion ELISA in radiologically confirmed liver mass cases is highly sensitive in detecting HHD and hence should be used along with ultrasonography for the screening of HHD followed by confirmation with cytology even in cases with a higher OD/CO of ELISA.

Role of Ultrasound guided Fine needle Aspiration in diagnosis of liver mass lesion

Fine Needle Aspiration of the liver is a simpler technique and is reported to yield higher positivity in patients with hepatic malignancy as compared to core biopsy. Fine needle aspiration cytology has the advantage of causing significant less discomfort and a very low risk of complication. Of all the radiological procedures the ultrasound is most suited for fine needle aspiration cytology as real time images can be obtained and it prevents the perforation of gall bladder, colon and blood vessels, Ultrasound has higher level of practicality, requires no ionizing radiation and is widely applicable as compare to computerised tomography scan. Aim of the present study is to establish role of Ultrasound guided Fine Needle Aspiration in diagnosis of liver mass lesions. Methods : We have performed UGS guided FNAC on 42 suspected cases of liver mass lesion. Detail history, clinical examination was done and consent was taken from patient after explaining the procedure to them. Bleeding time, Clotting time and Prothrombin time were done prior to procedure. All patients with liver mass lesion diagnosed on radiology were included in the study. Under all aseptic precaution Ultrasound guided FNAC was done from liver mass lesion using 26 gauge lumbar puncture needle. The material obtained in the needle was expelled onto glass slide and smear was made by opposition technique. Results: Of 42 aspirates from liver, 13 were diagnosed as hepatocellular carcinoma, 23 were diagnosed as metastatic carcinomas. Attempt of grading and study of cellular patterns was done in hepatocellular carcinoma. Of 23 cases of metastatic carcinoma, in 11 cases primary site could be demonstrated. In 12 cases primary site could not be determined. 18 were adenocarcinomas and 5 were undifferentiated anaplastic carcinoma. Conclusion: Ultrasound guided Fine Needle Aspiration of liver mass is safe ,cost effective technique in localizing Liver lesion and acquiring adequate material for preoperative diagnosis of mass lesion of liver

Interpretation of core biopsy of liver mass lesions: A comparison study between cytopathologist and gastrointestinal pathologist

ContextCore biopsy (CB) is a main tool for diagnosis of liver mass lesions. When CB is performed with fine needle aspiration (FNA), the CB may be interpreted by a cytopathologist or gastrointestinal pathologist. ObjectiveThis study compares interpretation of liver mass biopsy between cytopathologist and gastrointestinal pathologist in the era of subspecialty practice. Design349 liver mass lesions with FNA and CB performed during a 5-year period were retrieved. All cases were initially interpreted by a cytopathologist and retrospectively reviewed by a gastrointestinal pathologist. ResultsThe overall agreement was 95.1% (332/349 cases). There was agreement on 57/65 non-neoplastic cases (87.7%) with 8 (12.3%) discordant cases including 4 steatosis (steatohepatitis missed in 3 cases, 1 re-interpreted as focal nodular hyperplasia [FNH]); 3 inflammation (1 necrotizing granulomatous inflammation, 1 massive necrosis instead of fibrosing cholestatic hepatitis, and 1 hepatocellular carcinoma [HCC] was missed); and 1 initially deemed normal re-interpreted as FNH. There was agreement on 275/284 neoplastic cases (96.8%), with 9 (3.2%) discordant cases including: 2 initially interpreted as HCC (1 metastatic adrenal cortical carcinoma, 1 cholangiocarcinoma); 3 adenocarcinomas (2 further defined as prostatic primary, 1 well-differentiated neuroendocrine tumor [WDNET]); 2 metastatic carcinomas (1 tumor-induced fibrosis instead of cirrhosis, 1 LCNEC re-interpreted as WDNET); 1 poorly differentiated carcinoma (re-interpreted as LCNEC); and 1 sarcomatoid carcinoma (re-interpreted as leiomyosarcoma). ConclusionCytopathologist and gastrointestinal pathologist are highly concordant in the interpretation of neoplastic liver mass CB. Consultation may improve accuracy in certain non-neoplastic biopsies and neuroendocrine neoplasms.

Ultrasonografi kılavuzluğunda 18 ve 20 gauge kesici iğneler ile yapılan perkütan karaciğer kitle biyopsisi sonuçlarının karşılaştırılması

Aim: To evaluate the role of using 18 Gauge (G) and 20G sharp needles in ultrasonography (US)-guided percutaneous liver mass biopsy regarding diagnostic success and efficacy is aimed.Materials and Methods: Sixty patients who underwent US-guided liver mass biopsy using 18G and 20G cutting needles were included in the study. Definite diagnosis was established based on results of histopathological examinations of the biopsied lesions, follow-up clinical and imaging findings and for performed patients the results of repeated biopsy. In addition, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for 18G and 20G needles.Results: Among 60 liver masses, definite diagnosis was malignant in 54 (90%) masses and benign in 6 (10%) masses. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 90.7%, 100.0%, 100.0%, 75.0%, and 91.6%, respectively, for the liver mass biopsies performed with 18G needles. These values were 87.0%, 100.0%, 100.0%, 66.7%, and 88.3%, respectively, for the liver mass biopsies performed with 20G needles. No significant difference was determined between the results found for the use of 18G needle and 20G needle in US-guided cutting needle biopsy performed in hepatic masses (p=0.540)Conclusion: The present study demonstrated that 18G and 20G sharp needles had similar diagnostic success and efficacy in US-guided percutaneous biopsy of liver mass lesions. Owing to its fine calibration, 20G sharp needle can be preferred in high-risk patient groups, particularly in those with bleeding disorder.

03:00 PM Abstract No. 411 A slice of normal liver in pediatric liver tumors: do we need it?

Histologic evaluation of focal liver disease and mass lesions can be challenging. In a pediatric population, inadequate sampling or unclear diagnosis can lead to repeat biopsies that require general anesthesia. Adding non-lesional liver tissue (NLT) or transitional liver tissue (TLT) to standard biopsy procedures may aid pathologists in reaching a diagnosis. We aim to evaluate the safety, outcomes, and utility of adding NLT/TLT to evaluate pediatric liver lesions. Chart review revealed 36 liver lesion biopsies occurred from January 2016 to July 2018 at a tertiary care children’s hospital. Results were screened for NLT and TLT cases with exclusion of transplant patients (n=14). TLT was defined as the interface between radiologically NLT and the lesion of concern. A non-lesional liver sample was obtained using a 16- or 18-gauge coaxial system, before positioning the needle into the lesion. Among 10 boys and 4 girls (mean age 9.0 years, range 1–19 years), fine-needle aspiration (FNA) (mean 2.1 FNAs per procedure), NLT core biopsy (mean 1.6 cores), TLT core biopsy (mean 2.0 cores), and lesional core biopsy (mean 5.9 cores) were performed. NLT/TLT sample utility was subjectively evaluated by a pathologist. NLT was abnormal in 3 patients and normal in 11 patients. The pathologist reviewing these patients found NLT/TLT helpful in all cases, even if the tissue was normal. Only a single case (7.1%) required 2 separate incisions to obtain NLT and lesional tissue. On average, 2.6 additional core biopsies were performed to obtain NLT or TLT. All biopsies led to a final diagnosis without further tissue sampling. Pre- and post-procedural hemoglobin demonstrated no significant changes over 24 hours (p>.05). No intraprocedural or post-procedural complications were observed. In one case, comparison of NLT to the lesion enabled pathologists to identify malignant features within the NLT, aiding in the diagnosis of early metastatic neuroendocrine tumor. Obtaining additional NLT/TLT during a liver mass biopsy is not only safe, but also beneficial in making an accurate diagnosis. However this study is limited due to the small sample size and possible subjective bias of pathologists.

Diagnosis and Risk Factors of Postoperative Bile Leakage

The article presents the results of the examination of 165 patients with liver mass lesions, who underwent liver resection. A comprehensive study has been carried out in postoperative bile leakages with the identification of the most highly informative methods for early diagnosis, detection of source and causes of bile leakage. The study identified predictors of biliary complications.

Role of guided fine needle aspiration cytology in mass lesions of liver

Introduction: High incidence of liver diseases is seen in our country. Diseases of liver that present as a mass lesion can be a diagnostic dilemma. Nowadays guided fine needle aspiration cytology (FNAC) is utilized with greater frequency to identify and diagnose such lesions. The present study was carried out to investigate the profile of liver diseases presenting as a mass lesion in a primary care setting, using guided FNAC as a diagnostic tool. Amongst these patients, efficacy of FNAC in segregating a cohort that needs palliative care only – at the level of primary care medical facility - is also analysed. This would help in minimizing the economic burden of the patient and the expenditure entailed by the society; thereby allowing proper use of scarce medical facilities in resource poor countries. Methods: CT or ultrasound guided FNAC was carried out in 83 patients in a primary medical care facility. Based on cytological diagnosis, their demographic profile was analysed. Results: Primary or secondary malignancy was diagnosed in 46 patients. Metastatic carcinoma comprised the predominant group amongst neoplastic lesions of the liver. In 28 patients, diagnosis of pyogenic or amoebic abscess or hydatid cyst was made. It was possible to identify with the help of guided FNAC, a group of patients suitable for palliative care only. Conclusions: Guided FNAC is a cost effective investigative modality at the level of primary care medical facility for diagnosis of mass lesions in liver. Keywords: Guided aspiration cytology, Mass lesions of liver, Pyogenic liver abscess, liver metastasis

Diagnostic workup of liver lesions: Too long time with too many examinations

Objective. Liver mass lesions are often detected incidentally. Subsequent imaging examinations and surveillance are not only expensive, but may also cause unnecessary concern to patients. The aim of this study was to evaluate retrospectively the possible delay in acquiring the diagnosis of liver mass lesions, and to estimate the number of imaging examinations performed during the diagnostic workup. Patients and methods. The study comprised 200 patients with liver mass lesion of unknown etiology. The time needed from referral to final diagnosis was assessed. All imaging examinations and biopsy findings (if available) during the diagnostic workup were recorded. Results. Out of the 200 lesions, 133 were malignant, 65 with hepatocellular cancer and 26 with cholangiocarcinoma. All except one were diagnosed within 8 weeks. Of the 67 benign lesions, there were 20 focal nodular hyperplasias and 20 hemangiomas. For the benign lesions, in 37% the diagnostic workup took >8 weeks. Repeated examinations were more common in benign lesions; but often redundant in both benign and malignant conditions in retrospect analysis. Conclusions. To confirm the diagnosis, benign lesions required more follow-up time and more repeated imaging examinations than malignant ones. A long surveillance for liver mass lesions in fear of malignancy seems not to be necessary, since virtually all malignant lesions were diagnosed within 8 weeks. Evaluating all lesions in a multidisciplinary team right from the beginning is advocated by a prospective study design.

Fine needle aspiration cytology of lesions of liver and gallbladder: An analysis of 400 consecutive aspirations.

Background:Patients presenting with mass lesions of liver and gallbladder are a common occurrence in a cancer hospital in north central part of India. Fine-needle aspiration cytology (FNAC) serves as first line of pathological investigations, but there are pros and cons involved.Aim:The main objective of the present study was to establish adequacy of the procedure and to find out diagnostic pitfalls. An attempt was made to analyze inconclusive and inadequate aspirations.Materials and Methods:A total of 400 consecutive fine-needle aspirates of liver, belonging to 328 cases over a period of 2 years, were analyzed. Hematoxylin and eosin and May-Grόnwald-Giemsa stains were used. Chi-square test was carried out to compare significant degree of difference in different kind of diagnosis.Results:Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate. Among positive aspirations the most common was metastatic adenocarcinoma, 128 (44.2%). The positive diagnosis and adequate aspirations were significantly high (P < 0.0001). Major differential diagnostic problems were: Distinguishing the poorly differentiated hepatocellular carcinoma from the metastatic adenocarcinoma; and leukemia/lymphoma from other malignant round cell tumors. Common diagnostic pitfalls were repeated aspirations from the necrotic area and aspiration of atypical, disorganized and reactive hepatocytes, adjacent to a metastasis. No complications were observed.Conclusion:FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy. Study indicates the potential of using FNAC in clinical intervention where the incidence of gall-bladder and liver cancer is very high and open biopsy and surgery are not an option.

OP-149 CORONARY ARTERY FISTULAS IN IRAQI ADULT PATIENTS

Results: 177 extracardiac findings have been found at 80 (42.1%) cases. It was found that there were minor findings at 40 (20%) of the cases and there were major findings at 40 (20%) of the cases. We found that at 13 (6.8%) cases there were a total of 13 highly significant findings containing aortic aneurysm, pulmonary mass, pulmonary nodules, infiltrates, pneumonectomy, adrenal nodular thickening and liver mass lesions. Conclusion: Because extracardiac structures such as lungs, mediastinum and upper abdomen are being appropriate for evaluating with coronary calcium scoring with multidetector computed tomography and extracardiac findings are frequent, the radiologist who has been reporting these findings should be aware of the likelihood, frequency and importance of these findings.

Cytopathologic diagnosis of liver mass lesions.

The liver is a common site for metastatic malignancies, particularly from the gastrointestinal tract. It also may be involved by primary neoplasms, both benign and malignant. Cytopathologic examination of mass lesions of the liver with pertinent use of ancillary studies is a useful method of establishing a correct diagnosis for patient management. The authors reviewed the literature for articles pertaining to cytologic characteristics of specific tumor types, utility of immunohistochemical markers and pertinent molecular studies, differential diagnoses and pitfalls.

Fine needle aspiration biopsy of malignant mass lesions in the liver: a revisit of diagnostic profiles and challenges.

Fine needle aspiration biopsy (FNAB) of the liver with 20-23 G needles under radiologic guidance has been shown to be a safe and efficacious tool for procuring small tissue samples from liver mass lesions (1-3). The advantages of percutaneous (transabdominal) FNAB are well documented. However, as with all small samples, there are limitations of sampling error and insufficient material for ancillary tests. Part of this shortfall can be overcome by multiple sampling (up to 4 passes) of different parts of large lesions. Of late, endoscopic ultrasound-guided FNA (EUS-FNA) has emerged as a superior technique to access the left lobe, hilarstuctures and small deep-seated lesionsin the liver; thereby increasing the sensitivity and accuracy of radiologic detection and intrahepatic staging (4-6). Some hepatologists prefer 16-18 G core needle biopsies (CNB) whenever the situation permits (7-8). Although the histologic material allows for appreciation of architecture, spatial relationship and home tissue, and more material is available for performing ancillary tests, the wider bore needles are shorter and less flexible. Furthermore, there is a greater risk of bleeding amongst other contraindications/complications.

Pigmented hepatocellular adenoma with complete CD34 immunostaining pattern: A diagnostic dilemma

WHO defines hepatocellular adenoma (HCA) as a benign tumor composed of cells closely resembling normal hepatocytes, which are arranged in plates separated by sinusoids. It is more common in women. The present concerns a 41 years female who was found to have a mass lesion in liver on ultrasound while undergoing routine evaluation for dyspepsia. Computed tomography scan of abdomen showed 10×8 cm lesion in liver. Extended left hepatectomy was performed. Grossly hepatic cut surface showed circumscribed tumor with dark gray or black color. Microscopy revealed hepatocellular adenoma with abundant Dubin Johnson like pigment deposition. CD34 immunostaining showed complete sinusoidal pattern. We labeled the tumor as pigmented hepatic adenoma with complete CD34 staining pattern. To the best of author's knowledge only eight cases of pigmented hepatocellular adenoma are described in world literature.

Solitary skull metastasis as initial manifestation of hepatocellular carcinoma

BackgroundA solitary skull metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor without liver dysfunction is a very rare event.Case presentationA 71-year-old male, without known liver disease, presented to our institution with a palpable occipital scalp mass. On brain magnetic resonance imaging (MRI), a highly enhanced and osteolytic skull tumor was observed. The histological diagnosis obtained from the percutaneous needle biopsy was a cranial metastasis from HCC. The metastatic tumor was removed via occipital craniectomy, and the two primary liver mass lesions were subsequently treated by transarterial chemoembolization.ConclusionAn isolated skull metastasis may be the sole initial presentation of HCC. Early diagnosis is essential in order to treat the primary disease. A skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.

Staging Hepatocellular Carcinoma by a Novel Scoring System (BALAD Score) Based on Serum Markers

Previously proposed staging systems for hepatocellular carcinoma (HCC) involve clinical, imaging, or pathologic factors in the evaluation. We established and validated a novel staging system for HCC that is based on simply serum markers. The new scoring system is based on 5 serum markers: bilirubin, albumin, Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) and thus is termed the BALAD score. The system was validated in 2600 HCC patients from 5 institutions. The power of our system to predict patient survival and its discriminative ability were compared with those of previously reported staging systems. The best tumor marker cutoff values were 400 ng/dL for AFP, 15% for AFP-L3, and 100 milli-arbitrary unit/mL for DCP. The patients were classified into 6 categories on the basis of 5 laboratory values. The categories reflected patient survival well. The discriminative ability was comparable to that of previously reported staging systems. The new staging system for HCC combining serum albumin, serum bilirubin, and 3 tumor markers predicts patient outcomes with excellent discriminative ability. The system is easy to use and objective. In addition, stage can be evaluated with the use of only 1 serum sample. It also allows global comparison of patients with HCC or comparison of patients from different time periods with the same standard.

Accuracy of frozen section in the diagnosis of liver mass lesions

Objective: To evaluate the diagnostic accuracy of intraoperative frozen sections diagnosis of liver lesions thought to be malignant tumours. Methods: 285 frozen sections of liver from 173 patients were reviewed....