Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: The importance of tumor cell differentiation


  • Potential conflict of interest: Angelo Sangiovanni is a speaker and teacher for Bayer and has received travel support from Bayer. Alessio Aghemo is on an advisory committee for Roche and has received travel support from Bristol-Myers Squibb, Glaxo-Smith-Kline, and Roche. Massimo Iavarone has received travel support from Bayer. Dr. Colombo received support from Schering-Plough, Roche, Bristol-Myers Squibb, Gilead, Bayer Advisory Committees: Schering-Plough, Roche, Novartis, Vertex, Bristol-Myers Squibb, Gilead, Bayer, Tibotec, and is on the speakers' bureau of Schering-Plough, Roche, Novartis, Vertex, Bristol-Myers Squibb, Gilead Bayer.


Dynamic contrast imaging techniques are considered the standard of care for the radiological diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. However, the accuracy of radiological diagnosis depends largely on the degree of arterial hypervascularization, which increases with tumor size. Owing to the interplay and prognostic relevance of tumor vascularization and cell differentation, we asked ourselves whether tumor grade also affects the outcome of radiological diagnosis. Sixty-two HCCs (47 of which measured 1-2 cm) were consecutively detected in 59 patients with compensated cirrhosis under surveillance with ultrasound and confirmed by way of echo-guided biopsy and concurrent investigations with contrast-enhanced ultrasound (CE-US), computed tomography (CT), and gadolinium magnetic resonance imaging (MRI). Tumor cell differentiation was evaluated using Edmondson-Steiner criteria in liver cores of 0.9-5.0 cm (median 1.6 cm). Eighteen (29%) HCCs were grade I (1.5 cm), 28 (45%) were grade II (1.5 cm), 16 (26%) were grade III (1.8 cm), and none were grade IV. Contrast wash-in and wash-out were concurrently demonstrated in 21 (34%) tumors by way of CE-US, including three (16%) grade I and 18 (41%) grade II-III (P = 0.08); in 32 (52%) tumors by way of CT, including three (16%) grade I and 29 (66%) grade II-III (P = 0.0006); and 28 (47%) tumors by way of MRI, including three grade I (16%) and 25 (57%) grade II-III (P = 0.01). Among 1- to 2-cm tumors, the radiological diagnosis was achieved in two of 16 grade I and 17of 31 grade II-III tumors (P = 0.006). Conclusion: Tumor grade, a relevant predictor of disease severity, influences the accuracy of dynamic contrast techniques in the diagnosis of HCC. HEPATOLOGY 2010