Hepatocellular carcinoma other diagnostic studies
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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.
Other Diagnostic Studies
Liver Biopsy
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]
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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.