Hepatocellular Carcinoma in Cirrhotic Liver: CT Findings and AFP Association
Hepatocellular Carcinoma in Cirrhotic Liver
Keywords:
hepatocellular carcinoma (HCC), computed tomography (CT), alpha-fetoprotein (AFP)Abstract
Most liver cancer diagnosis currently uses computed tomography (CT) with the alpha-fetoprotein (AFP) level, but there is no study of the relationship between the AFP level and liver cancer CT. The purpose of this study was to determine CT findings characterization of HCC and association with AFP level. Two hundred and one patients with diagnosis of malignant of liver according to ICD10 (C220, C221 and C229) were reviewed between June 2015 and April 2019 at Somdejphrajaotaksin Maharaj Hospital. Seventy-two patients were met the CT diagnosis of HCC criteria with cirrhosis findings. Cases divided into three groups: Group one with low AFP level (< 20 IU/ml), Group two with moderate AFP level (20-400 IU/ml) and Group three with high AFP level (> 400 IU/ml). Of these, there were 19 (26.4%), 21 (29.2%) and 32 patients (44.4%) in Groups one, two and three, respectively. CT findings of HCC (location, margin, heterogeneous enhancement, fat component) were no significant association with AFP levels. HCC patients with high AFP level tended to have greater tumor size, tumor number, portal vein thrombosis, positive lymph nodes and rupture of tumor. But even among low AFP level, extrahepatic metastasis was found up to 10.5% (overall 13.8%). In conclusion, AFP is useful for prognostic indicator, but it is not a reliable indicator in the early detection in patients with HCC.
References
2. Cancer Registry Unit, National Cancer Institute Thailand. Cancer in Thailand, Vol.IX, 2013-2015. Bangkok: New Thammada Press (Thailand) Co.,Ltd; 2018.
3. Thai Association for the Study of the Liver. Thailand Guideline for Management of Hepatocellular Carcinoma 2019. Nonthaburi:Parbpim Ltd; 2019.
4. Bruix J, Sherman M. Management of hepatocelluar carcinoma: An update. Hepatology 2011;53(3):1020-2.
5. Bargellini I, Battaglia V, Bozzi E, Lauretti DL, Lorenzoni G, Bartoiozzi C. Radiological diagnosis of hepatocellular carcinoma. J Hepatocell Carcinoma [online]. 2014 [cited 2017 June 20];1:137-48. Available from: http://dx.doi.org/10.2147/JHC.S44379
6. Trevisani F, D'Intino PE, Morselli-Labate AM, Mazzella G, Accogli E, Careaceni P, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: Influence of HBsAg and anti-HCV status. J Hepatol 2001;34(4):570-5.
7. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis staging and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018;68(2):723-50.
8. Bureau of Audit, National Health Security Office. Medical Record Audit Guideline 2019. Nonthaburi: Sahamit Printing and Publishing; 2018.
9. Zhang J, Chen G, Zhang P, Zhang J, Li X, Gan D, et al. The threshold of alphafetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: A systemic review and meta-analysis. PLOS ONE [online]. 2020 [cited 2020 Mar 2]. Available from: https://doi.org/10.1371/journal.pone. 0228857
10. Karahan OI, Yikilmaz A, Isin S, Orhan S. Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings. Acta Radiologica 2003;44(6):566-71.
11. Choi JY, Lee JM, Sirlin CB. CT and MR imagining diagnosis and staging of hepatocellular carcinoma: Part I. Development, growth, and spread: Key pathologic and imaging aspects. Radiology 2014;272(3):635-54.
12. Choi JY, Lee JM, Sirlin CB. CT and MR imagining diagnosis and staging of hepatocellular carcinoma: Part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2014;273(1):30-50.
13. Tangkijvanich P, Anukulkamkusol N, Suwangool P, Lertmaharit S, Hanvivatvong O, Kullavanijaya P, et al. Clinical characteristics and prognosis of hepatocellular carcinoma: Analysis based on serum alphafetoprotein levels. J Clin Gastroenterol
2000;31(4):302-8.
14. Chan MY, She WH, Dai WC, Tsang SHY, Chok KSH, Chan ACY, et al. Prognostic value of preoperative alpha-fetoprotein (AFP) level in patients receiving curative hepatectomy-an analysis of 1,182 patients in Hong Kong. Transl Gastroenterol Hepatol [online]. 2019 [cited 2020 Feb 20];4:52. Available from: https://dx.doi.org/10.21037/ tgh.2019.06.07
15. Chen DS, Sung JL, Sheu JC, Lai MY, How SW, Hsu HC, et al. Serum alpha-fetoprotein in the early stage of human hepatocellular carcinoma. Gastroenterology 1984;86(6):1404-9.
16. Sherman M. Alpha-fetoprotein: An obituary. J Hepatol 2001;34(4):603-5.
