Hepatocellular carcinoma other diagnostic studies: Difference between revisions
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==Key Findings in biopsy in Hepatocellular Carcinoma== | ==Key Findings in biopsy in Hepatocellular Carcinoma== | ||
The diagnosis of hepatocellular carcinoma is confirmed by [[percutaneous]] [[biopsy]] and histopathologic analysis. | The diagnosis of hepatocellular carcinoma is confirmed by [[percutaneous]] [[biopsy]] and histopathologic analysis. | ||
* Core liver [[biopsy]] is the gold standard test for the diagnosis of hepatocellular carcinoma. | |||
* Two out of the following three positive stains upon liver biopsy confirm HCC:<ref name="pmid19177576">{{cite journal |vauthors= |title=Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia |journal=Hepatology |volume=49 |issue=2 |pages=658–64 |year=2009 |pmid=19177576 |doi=10.1002/hep.22709 |url=}}</ref><ref name="pmid20400233">{{cite journal |vauthors=Karabork A, Kaygusuz G, Ekinci C |title=The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma |journal=Pathol. Res. Pract. |volume=206 |issue=8 |pages=572–7 |year=2010 |pmid=20400233 |doi=10.1016/j.prp.2010.03.004 |url=}}</ref> | |||
** [[Glypican 3]] | |||
** [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]] | |||
**[[Glutamine synthetase]] | |||
==== The comparison table for diagnostic studies of choice for hepatocellular carcinoma:<ref name="pmid18471552">{{cite journal |vauthors=El-Serag HB, Marrero JA, Rudolph L, Reddy KR |title=Diagnosis and treatment of hepatocellular carcinoma |journal=Gastroenterology |volume=134 |issue=6 |pages=1752–63 |year=2008 |pmid=18471552 |doi=10.1053/j.gastro.2008.02.090 |url=}}</ref> ==== | |||
{| class="wikitable" | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diagnostic Test | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | |||
|- | |||
! style="background: #696969; color: #FFFFFF; text-align: center;" |Percutaneous Ultrasound guided liver biopsy | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90% | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |91% | |||
|- | |||
! style="background: #696969; color: #FFFFFF; text-align: center;" |Percutaneous CT guided liver biopsy | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |92% | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |98% | |||
|} | |||
===== Sequence of Diagnostic Studies ===== | |||
The core needle biopsy should be performed when:<ref name="pmid23091805">{{cite journal |vauthors=Song DS, Bae SH |title=Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period |journal=Clin Mol Hepatol |volume=18 |issue=3 |pages=258–67 |year=2012 |pmid=23091805 |pmc=3467428 |doi=10.3350/cmh.2012.18.3.258 |url=}}</ref> | |||
* A positive hepatic leision is detected in the patient on imaging studies. | |||
* The patient has underlying risk factors i.e HBV infection,HCV infection or liver cirrhosis. | |||
=== Diagnostic Criteria === | |||
* Hepatocellular carcinoma may be diagnosed at any time if the following criteria is met: | |||
** Two out of the following three positive stains upon liver biopsy confirm HCC:<ref name="pmid19177576" /> | |||
*** [[Glypican 3]] | |||
*** [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]] | |||
***[[Glutamine synthetase]] | |||
===Hepatic venous pressure gradient measurement=== | ===Hepatic venous pressure gradient measurement=== | ||
Revision as of 15:24, 11 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Other diagnostic studies for hepatocellular carcinoma include laparoscopy and biopsy.
Key Findings in biopsy in Hepatocellular Carcinoma
The diagnosis of hepatocellular carcinoma is confirmed by percutaneous biopsy and histopathologic analysis.
- Core liver biopsy is the gold standard test for the diagnosis of hepatocellular carcinoma.
- Two out of the following three positive stains upon liver biopsy confirm HCC:[1][2]
The comparison table for diagnostic studies of choice for hepatocellular carcinoma:[3]
| Diagnostic Test | Sensitivity | Specificity |
|---|---|---|
| Percutaneous Ultrasound guided liver biopsy | 90% | 91% |
| Percutaneous CT guided liver biopsy | 92% | 98% |
Sequence of Diagnostic Studies
The core needle biopsy should be performed when:[4]
- A positive hepatic leision is detected in the patient on imaging studies.
- The patient has underlying risk factors i.e HBV infection,HCV infection or liver cirrhosis.
Diagnostic Criteria
- Hepatocellular carcinoma may be diagnosed at any time if the following criteria is met:
- Two out of the following three positive stains upon liver biopsy confirm HCC:[1]
Hepatic venous pressure gradient measurement
- Hepatic venous pressure gradient (HVPG) measurement is the difference between hepatic venous wedge pressure (HVWP) and free hepatic venous pressure (FHVP).
- HVPG reflects the intra-sinusoidal pressure.[5]
- The HVPG of over 10 mmHg is associated with a 6-fold increase of HCC risk.[6]
- HVPG is measured through insertion of a catheter in right internal jugular vein.[7]
{{#ev:youtube|9cEOpr-MRL4|500}}
References
- ↑ 1.0 1.1 "Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia". Hepatology. 49 (2): 658–64. 2009. doi:10.1002/hep.22709. PMID 19177576.
- ↑ Karabork A, Kaygusuz G, Ekinci C (2010). "The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma". Pathol. Res. Pract. 206 (8): 572–7. doi:10.1016/j.prp.2010.03.004. PMID 20400233.
- ↑ El-Serag HB, Marrero JA, Rudolph L, Reddy KR (2008). "Diagnosis and treatment of hepatocellular carcinoma". Gastroenterology. 134 (6): 1752–63. doi:10.1053/j.gastro.2008.02.090. PMID 18471552.
- ↑ Song DS, Bae SH (2012). "Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period". Clin Mol Hepatol. 18 (3): 258–67. doi:10.3350/cmh.2012.18.3.258. PMC 3467428. PMID 23091805.
- ↑ Boyer TD (2006). "Wedged hepatic vein pressure (WHVP): ready for prime time". Hepatology. 43 (3): 405–6. doi:10.1002/hep.21118. PMID 16496346.
- ↑ Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS (2009). "Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis". J. Hepatol. 50 (5): 923–8. doi:10.1016/j.jhep.2009.01.014. PMID 19303163.
- ↑ Chelliah ST, Keshava SN, Moses V, Surendrababu NR, Zachariah UG, Eapen C (2011). "Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques". Indian J Radiol Imaging. 21 (4): 291–3. doi:10.4103/0971-3026.90693. PMC 3249946. PMID 22223943.