Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules
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Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound‑detected liver nodules Maria Stella Franzè1 · Antonio Bottari2 · Simona Caloggero3 · Alessia Pitrone3 · Adalberto Barbera4 · Tindaro Lembo1,8 · Gaia Caccamo1 · Irene Cacciola5 · Sergio Maimone1 · Angela Alibrandi6 · Concetta Pitrone1 · Giovanni Squadrito7 · Giovanni Raimondo1,5 · Carlo Saitta1 Received: 31 July 2020 / Accepted: 13 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Ultrasound (US) detection of liver nodules in cirrhotic patients requires further radiological examinations and often a followup with repeated short-term evaluations to verify the presence of hepatocellular carcinoma (HCC). Aims of the study were to assess the rate of HCC diagnosis and to identify HCC predictors in a cohort of cirrhotics followed-up after US detection of the liver nodule(s). One-hundred-eighty-eight consecutive cirrhotic patients (124 males, mean age 64.2 years) with liver nodule(s) detected by US were enrolled. All patients underwent second-level imaging [computed tomography (TC) or magnetic resonance (MR)], and those without a definite diagnosis of HCC were followed-up with TC and/or RM repeated every 3–6 months up to 18 months if HCC was not diagnosed. After 18 months, non-HCC patients came back to routine US surveillance. HCC was diagnosed in 73/188 cases (38.8%). In 66/73 patients (90.4%) HCC was identified at first radiological evaluation after US, while in the remaining seven subjects it was diagnosed at the subsequent imaging examination. Age (p = 0.001) and nodule dimension (p = 0.0001) were independent predictors of HCC at multivariate analysis. Fourty-nine/188 patients were lost at follow up after 18 months. Twenty/139 remaining patients developed HCC and 3/139 cholangiocarcinoma; 77 died between 3 and 110 months from the beginning of the study (61 for end-stage liver disease, 8 for extrahepatic causes, eight for unknown causes). Patients who developed liver cancer earlier during the follow up had the shortest overall survival. US-detected liver nodules are not neoplastic in more than half of cirrhotic patients. A definite diagnosis may be obtained at the time of the first radiologic evaluation after US in the vast majority of the cases. Patients in whom nodules are found not to be tumoral may return to the US surveillance program routinely applied to all cirrhotics. Keywords Cirrhosis · HCC · Liver nodules · Surveillance · Ultrasound
* Carlo Saitta [email protected] 1
Division of Medicine and Hepatology, Department of Medical Sciences, University Hospital of Messina, Via Consolare Valeria, 1 ‑ 98124 Messina, Italy
2
Division of Radiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
3
Division of Radiology, Department of Radiology and Radiotherapy, University Hospital of Messina, Messina, Italy
4
Division of Oncologic Surgery, Department of Human Pathology, University of Messina, Messina, Italy
5
Divi
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