Hepatocellular carcinoma Diagnostic study of choice: Difference between revisions

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===== Gold standard: =====
===== Gold standard: =====
* Liver [[biopsy]] is the gold standard test for the diagnosis of hepatocellular carcinoma.
* Core liver [[biopsy]] is the gold standard test for the diagnosis of hepatocellular carcinoma.
* Two out of the following three 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>
* 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>
** [[Glypican 3]]  
** [[Glypican 3]]  
** [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]]  
** [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]]  
**[[Glutamine synthetase]]
**[[Glutamine synthetase]]
* The core needle biopsy should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== 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> ====
==== 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> ====
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===== Diagnostic results =====
Two out of the following three stains upon liver biopsy confirms HCC:
* [[Glypican 3]]
* [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]]
*[[Glutamine synthetase]]
===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
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>
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive nodule is detected in the patient on imaging studies.
* A positive [test] is detected in the patient, to confirm the diagnosis.
* The patient has underlying risk factors i.e HBV infection,HCV infection or liver cirrhosis.
 
=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
* Hepatocellular carcinoma may be diagnosed at any time if two or more of the following criteria are met:  
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
** Two out of the following three positive stains upon liver biopsy confirm HCC:<ref name="pmid19177576" />
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*** [[Glypican 3]]  
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*** [[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]]  
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
***[[Glutamine synthetase]]
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Revision as of 16:06, 3 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Diagnostic Study of Choice

Gold standard:

The comparison table for diagnostic studies of choice for hepatocellular carcinoma:[2]

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:[3]

  • A positive nodule 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

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.

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