Hepatocellular carcinoma Diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(42 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
 
{{Hepatocellular carcinoma}}
{{Hepatocellular carcinoma Diagnostic study of choice}}
{{CMG}}; {{AE}} {{SH}}
{{CMG}}; {{AE}} {{SH}}
== Overview ==
== Overview ==
Hepatocellular carcinoma is best diagnosed on a core [[biopsy]] of the [[liver]]. Core [[biopsy]] is done in a single visit at the hospital.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Gold standard/Study of choice: =====
'''Liver biopsy'''
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The [[diagnosis]] of hepatocellular carcinoma is confirmed by [[percutaneous]] [[biopsy]] and [[histopathologic]] analysis.
* The following result of [gold standard test] is confirmatory of [disease name]:
* [[Percutaneous]] [[biopsy]] should only be performed when [[Diagnosis|diagnostic]] imaging results are uncertain.  
** Result 1
** Result 2
* The [name of investigation] 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 [disease name] ====
* [[Percutaneous]] core [[liver]] [[biopsy]] is the [[Gold standard (test)|gold standard test]] for the [[diagnosis]] of hepatocellular carcinoma.
{|
* In addition to the percutaneous approach, there are various other approaches to obtain a sample of the hepatic tissue, such as:<ref name="pmid16636018">{{cite journal |vauthors=Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, Leandro G, Dhillon AP, Burroughs AK |title=Transjugular liver biopsy: how good is it for accurate histological interpretation? |journal=Gut |volume=55 |issue=12 |pages=1789–94 |year=2006 |pmid=16636018 |pmc=1856467 |doi=10.1136/gut.2005.090415 |url=}}</ref><ref name="pmid14562197">{{cite journal |vauthors=Hollerbach S, Reiser M, Topalidis T, König M, Schmiegel W |title=Diagnosis of hepatocellular carcinoma (HCC) in a high-risk patient by using transgastric EUS-guided fine-needle biopsy (EUS-FNA) |journal=Z Gastroenterol |volume=41 |issue=10 |pages=995–8 |year=2003 |pmid=14562197 |doi=10.1055/s-2003-42920 |url=}}</ref><ref name="pmid21291633">{{cite journal |vauthors=Wang L, Geng J, Li J, Li T, Matsumori A, Chang Y, Lu F, Zhuang H |title=The biomarker N-terminal pro-brain natriuretic peptide and liver diseases |journal=Clin Invest Med |volume=34 |issue=1 |pages=E30–7 |year=2011 |pmid=21291633 |doi= |url=}}</ref>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
**[[Transjugular intrahepatic portosystemic shunt|Transjugular]] approach
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
**[[Laparoscopic surgery|Laparoscopic]] radiographically guided fine-needle approach
**[[Endoscopic ultrasound]] ([[Endoscopic ultrasound|EUS]])-guided [[Fine-needle aspiration|fine-needle biopsy]] ([[Endoscopic ultrasound|EUS]]-[[Needle aspiration biopsy|FNA]])
* [[Percutaneous]] [[biopsy]] of focal lesions may be performed in combination with either [[ultrasound]] or [[CT|CT imaging]].<ref name="pmid15278290">{{cite journal |vauthors=Schirmacher P, Fleig WE, Tannapfel A, Langner C, Dries V, Terracciano L, Denk H, Dienes HP |title=[Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)] |language=German |journal=Pathologe |volume=25 |issue=5 |pages=337–48 |year=2004 |pmid=15278290 |doi=10.1007/s00292-004-0692-7 |url=}}</ref>
* [[Percutaneous]] [[liver biopsy]] remains the cornerstone of [[diagnosis]]. It is a quick and simple to perform [[liver biopsy]] in a patient with normal [[Platelet|platelet count]] and [[Prothrombin time|INR]].<ref name="pmid22833761">{{cite journal |vauthors=Tannapfel A, Dienes HP, Lohse AW |title=The indications for liver biopsy |journal=Dtsch Arztebl Int |volume=109 |issue=27-28 |pages=477–83 |year=2012 |pmid=22833761 |pmc=3402072 |doi=10.3238/arztebl.2012.0477 |url=}}</ref>
*Surgical resection
* 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]]
 
'''Hep Par 1 Antibody Stain'''
* Tissue [[microarray technology]] is uses to test Hep Par 1 [[antibody]] [[stain]] which is showing promising results in differential diagnosis of HCC.<ref name="Fanvan de Rijn2003">{{cite journal|last1=Fan|first1=Zhen|last2=van de Rijn|first2=Matt|last3=Montgomery|first3=Kelli|last4=Rouse|first4=Robert V.|title=Hep Par 1 Antibody Stain for the Differential Diagnosis of Hepatocellular Carcinoma: 676 Tumors Tested Using Tissue Microarrays and Conventional Tissue Sections|journal=Modern Pathology|volume=16|issue=2|year=2003|pages=137–144|issn=0893-3952|doi=10.1097/01.MP.0000052103.13730.20}}</ref>
 
* A [[biopsy]] is not necessary if the [[clinical]], [[Medical laboratory|laboratory]], and [[Radiologic sign|radiologic]] data suggest hepatocellular carcinoma.
* [[Liver biopsy]] may be suggestive of [[etiology]] as the following:
** [[Alcoholic liver disease]] : [[Liver biopsy]] may show [[hepatocyte]] [[necrosis]], presence of [[Mallory body|mallory bodies]], [[Neutrophil|neutrophilic]] infiltration and perivenular [[inflammation]].
** [[Primary biliary cirrhosis|Primary biliary cirrhosis]] : [[Gold standard (test)|Gold standard diagnostic modality]] is the detection of [[antimitochondrial antibodies]] along with [[liver biopsy]] as confirmation of florid [[bile duct]] lesions.
* There is a small but significant risk associated with [[liver biopsy]], and the underlying [[cirrhosis]] in the patients with HCC itself predisposes to complications due to [[liver biopsy]].<ref>{{cite journal |last=Grant |first=A|year=1999 | title=Guidelines on the use of liver biopsy in clinical practice |journal=Gut |volume=45 |issue=Suppl 4 |pages=1-11 |id=PMID 10485854 |url=http://gut.bmj.com/cgi/content/full/45/suppl_4/IV1|quote=The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding. }}</ref> 
*There is a 3% risk of tumor spread in the [[percutaneous]] needle path, risks of [[liver biopsy]] include:<ref name="pmid22047762">{{cite journal |vauthors=Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A |title=Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report |journal=Lancet Oncol. |volume=13 |issue=1 |pages=e11–22 |year=2012 |pmid=22047762 |pmc=3417764 |doi=10.1016/S1470-2045(11)70175-9 |url=}}</ref>
 
*[[Bleeding|Hemorrhage]]
*[[Bile duct|Biliary]] [[peritonitis]]
*[[Hematoma]]
*[[Perforation]] of other [[Viscus|viscera]]
*[[Mortality rate|Mortality rates]] of between 0.01% and 0.1%
 
* Patients with moderate [[coagulopathy]]: 
**Plugged [[liver biopsy]] : [[Injection]] of gelatin sponges or metal coils down the tract after [[biopsy]]
**[[Laparoscopic surgery|Laparoscopic]] [[liver biopsy]] performed on a sedated patient with moderate [[coagulopathy]]
***Advantage:
****Allows direct visualization of the [[liver]]
'''Transjugular [[liver biopsy]]:'''
* Used in patients with severe [[clotting]] disorders
**Advantage:
***Risk of [[Peritoneum|intraperitoneal]] [[Bleeding|bleed]] is less
** Disadvantages:
***[[Biopsy|Biopsies]] are small
***Multiple [[Biopsy|biopsies]] required 
***Taken 'blindly'
 
==== 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;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |Percutaneous Ultrasound guided liver biopsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |91%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #696969; color: #FFFFFF; text-align: center;" |Percutaneous CT guided liver biopsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |92%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |98%
|}
|}
<small> ✔= The best test based on the feature </small>
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2


===== 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 hepatic leision 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 the following criteria is 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" /><ref name="pmid28280721">{{cite journal |vauthors=Di Tommaso L, Roncalli M |title=Tissue Biomarkers in Hepatocellular Tumors: Which, When, and How |journal=Front Med (Lausanne) |volume=4 |issue= |pages=10 |year=2017 |pmid=28280721 |pmc=5322593 |doi=10.3389/fmed.2017.00010 |url=}}</ref>
*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].
=== Staging of hepatocellular carcinoma ===
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.Although the TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.<ref name="cancerca">Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab</ref>
 
===Primary tumor===
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
** Criteria 1
||TX
** Criteria 2
||Primary tumour cannot be assessed
** Criteria 3
|-
 
|T0||No evidence of primary tumour
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].
|T1||A single tumour with no invasion into the blood vessels of the liver
*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].
|T2||A single tumour with invasion into the blood vessels or multiple tumours, none more than 5 cm in size
IF there are no established diagnostic criteria: 
|-
*There are no established criteria for the diagnosis of [disease name].
|T3a||Multiple tumours, with any tumour larger than 5 cm
|-
|T3b||The tumour has grown into either the portal or hepatic vein
|-
|T4||The tumour has grown into nearby organs (other than the gallbladder) or the tumour has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum)
|}
===Regional lymph node===
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
|NX||Regional lymph nodes cannot be assessed
|-
|N0||No regional lymph node metastasis
|-
|N1||Regional lymph node metastasis
|}
===Distance metastasis===
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
|M0||No distant metastasis
|-
|M1||Distant metastasis
|}
===Clip and Okuda Staging Systems for Hepatocellular Carcinoma===
Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | isbn = 978-0-07-1802161 }}</ref>


'''CLIP Classification'''
{| class="wikitable"
!
! colspan="3" |Points
|-
|'''Variable'''
|0
|1
|2
|-
|[[Tumor|i.Tumor]] number (%)
|Single
|Multiple
|–
|-
|Hepatic replacement by tumor
|<50
|<50
|>50
|-
|ii. [[Child-Pugh score]]
|A
|B
|C
|-
|iii. α Fetoprotein level (ng/mL)
|<400
|≥400
|–
|-
|iv.[[Portal vein thrombosis]] (CT)
|No
|Yes
|–
|-
| colspan="4" |CLIP stages (score = sum of points): CLIP 0, 0 points; CLIP 1, 1 point; CLIP 2, 2 points; CLIP 3, more than 3
points.
|}'''OKUDA'''  '''Classification'''
{| class="wikitable"
| colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |'''OKUDA Classification'''
|-
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Tumor Extent*'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Bilirubin (mg/dL)'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Albumin (g/L)'''
| colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Ascites'''
|-
|≥50%
|<50
|≥ 3
|<3
|≤3
|>3
| +
|–
|-
|(+)
|(−)
|(+)
|(−)
|(+)
|(−)
|(+)
|(−)
|-
| colspan="8" |Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+).
|}


==References==
== References ==
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Emergency medicine]]

Latest revision as of 22:07, 29 July 2020

Hepatocellular carcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes of Hepatocellular carcinoma

Differentiating Hepatocellular carcinoma from other Diseases

Epidemiology & Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

Diagnostic study of choice

History and symptoms

Physical Examination

Lab Tests

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hepatocellular carcinoma Diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hepatocellular carcinoma Diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hepatocellular carcinoma Diagnostic study of choice

CDC on Hepatocellular carcinoma Diagnostic study of choice

Hepatocellular carcinoma Diagnostic study of choice in the news

Blogs on Hepatocellular carcinoma Diagnostic study of choice

Directions to Hospitals Treating Hepatocellular carcinoma

Risk calculators and risk factors for Hepatocellular carcinoma Diagnostic study of choice

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

Overview

Hepatocellular carcinoma is best diagnosed on a core biopsy of the liver. Core biopsy is done in a single visit at the hospital.

Diagnostic Study of Choice

Liver biopsy

Hep Par 1 Antibody Stain

Transjugular liver biopsy:

The comparison table for diagnostic studies of choice for hepatocellular carcinoma:[11]

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:[12]

Diagnostic Criteria

Staging of hepatocellular carcinoma

According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.Although the TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.[14]

Primary tumor

TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 A single tumour with no invasion into the blood vessels of the liver
T2 A single tumour with invasion into the blood vessels or multiple tumours, none more than 5 cm in size
T3a Multiple tumours, with any tumour larger than 5 cm
T3b The tumour has grown into either the portal or hepatic vein
T4 The tumour has grown into nearby organs (other than the gallbladder) or the tumour has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum)

Regional lymph node

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis

Distance metastasis

M0 No distant metastasis
M1 Distant metastasis

Clip and Okuda Staging Systems for Hepatocellular Carcinoma

Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.[15]

CLIP Classification

Points
Variable 0 1 2
i.Tumor number (%) Single Multiple –
Hepatic replacement by tumor <50 <50 >50
ii. Child-Pugh score A B C
iii. α Fetoprotein level (ng/mL) <400 ≥400 –
iv.Portal vein thrombosis (CT) No Yes –
CLIP stages (score = sum of points): CLIP 0, 0 points; CLIP 1, 1 point; CLIP 2, 2 points; CLIP 3, more than 3

points.

OKUDA Classification

OKUDA Classification
Tumor Extent* Bilirubin (mg/dL) Albumin (g/L) Ascites
≥50% <50 ≥ 3 <3 ≤3 >3 + –
(+) (−) (+) (−) (+) (−) (+) (−)
Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+).

References

  1. ↑ Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, Leandro G, Dhillon AP, Burroughs AK (2006). "Transjugular liver biopsy: how good is it for accurate histological interpretation?". Gut. 55 (12): 1789–94. doi:10.1136/gut.2005.090415. PMC 1856467. PMID 16636018.
  2. ↑ Hollerbach S, Reiser M, Topalidis T, König M, Schmiegel W (2003). "Diagnosis of hepatocellular carcinoma (HCC) in a high-risk patient by using transgastric EUS-guided fine-needle biopsy (EUS-FNA)". Z Gastroenterol. 41 (10): 995–8. doi:10.1055/s-2003-42920. PMID 14562197.
  3. ↑ Wang L, Geng J, Li J, Li T, Matsumori A, Chang Y, Lu F, Zhuang H (2011). "The biomarker N-terminal pro-brain natriuretic peptide and liver diseases". Clin Invest Med. 34 (1): E30–7. PMID 21291633.
  4. ↑ Schirmacher P, Fleig WE, Tannapfel A, Langner C, Dries V, Terracciano L, Denk H, Dienes HP (2004). "[Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)]". Pathologe (in German). 25 (5): 337–48. doi:10.1007/s00292-004-0692-7. PMID 15278290.
  5. ↑ Tannapfel A, Dienes HP, Lohse AW (2012). "The indications for liver biopsy". Dtsch Arztebl Int. 109 (27–28): 477–83. doi:10.3238/arztebl.2012.0477. PMC 3402072. PMID 22833761.
  6. ↑ 6.0 6.1 "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.
  7. ↑ 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.
  8. ↑ Fan, Zhen; van de Rijn, Matt; Montgomery, Kelli; Rouse, Robert V. (2003). "Hep Par 1 Antibody Stain for the Differential Diagnosis of Hepatocellular Carcinoma: 676 Tumors Tested Using Tissue Microarrays and Conventional Tissue Sections". Modern Pathology. 16 (2): 137–144. doi:10.1097/01.MP.0000052103.13730.20. ISSN 0893-3952.
  9. ↑ Grant, A (1999). "Guidelines on the use of liver biopsy in clinical practice". Gut. 45 (Suppl 4): 1–11. PMID 10485854. The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.
  10. ↑ Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A (2012). "Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report". Lancet Oncol. 13 (1): e11–22. doi:10.1016/S1470-2045(11)70175-9. PMC 3417764. PMID 22047762.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ Di Tommaso L, Roncalli M (2017). "Tissue Biomarkers in Hepatocellular Tumors: Which, When, and How". Front Med (Lausanne). 4: 10. doi:10.3389/fmed.2017.00010. PMC 5322593. PMID 28280721.
  14. ↑ Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab
  15. ↑ Kasper, Dennis. Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0-07-1802161.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Hepatocellular_carcinoma_Diagnostic_study_of_choice&oldid=1639250"