Does Preoperative Imaging Correlate With Explant Pathology in HCC?

Does Preoperative Imaging Correlate With Explant Pathology in HCC?

JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY DOES PREOPERATIVE IMAGING CORRELATE WITH EXPLANT PATHOLOGY IN HCC? Joy Varghese, Mayank Jain, Mukul V...

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JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY

DOES PREOPERATIVE IMAGING CORRELATE WITH EXPLANT PATHOLOGY IN HCC? Joy Varghese, Mayank Jain, Mukul Vij, Sanjay Govil, Deepashree M. Reddy, V. Jayanti, Mohamed Rela Global Health City, Chennai, India

Background and Aim: To assess the correlation of findings noted on preoperative CT scan with pathological examination of liver explants in patients who underwent liver transplant (LT) for hepatocellular carcinoma (HCC). Methods: This retrospective study was based on preoperative CT scan examination of HCC patients who underwent LT. Study group was classified into 2 groups. Group I (Gp I) was HCC patients within UCSF criteria and Group II (Gp II) was HCC patients beyond UCSF criteria. The validity, predictive values and reliability of CT scan in rightly classifying the participants based on UCSF criteria as compared to direct pathological examination of explant liver (considered as gold standard) was analysed. The validity was assessed by sensitivity, specificity, false positive and false negative rates. Reliability was assessed by calculating the kappa statistic and its P-value. Results: A total of 86 patients (71 males, mean age 55.1 years) over 5 years formed the study group. Fifty four patients (62%) underwent chemoembolisation prior to surgery. Eight patients had vascular invasion on preoperative imaging. The mean size and number of tumors assessed preoperatively were 2.74 cm (0.8–10 cm) and 2.70 (1–10). On explants evaluation, the mean size and number of tumors were 5.97 cm (0.7–11 cm) and 5.9 (1–10) respectively. The sensitivity of the CT scan in identifying patients with UCSF score beyond was very poor (53.2%, 95% CI 38.93–67.475), hence the rate of false negative reporting was high (46.8%, 32.53–61.06%). The CT scan had good specificity (84.6%, 73.27– 95.93%) in identifying people with UCSF criteria within range. The positive and negative predictive values of the test were 80.6% and 60% respectively. The kappa statistic of agreement between CT scan findings and explant examination was very poor (K = 0.117, P < 0.001). Conclusion: Preoperative imaging has a good specificity in patients with lesions within UCSF criteria. CONFLICTS OF INTEREST The authors have none to declare.

Corresponding author: Mayank Jain. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.116

12 A CASE OF AUTOIMMUNE—MIMIC JAUNDICE Jasmeet Singh Dhingra Tata Memorial Hospital, Mumbai, India

Background: In AIH, auto-antibodies can be detected in up to 95% patients. Our report describes a case of 46-year-old woman with an ovarian mass and unremitting jaundice with biopsy features of early AIH and with both initial CA-125 and ANA negative which finally turned out be metastatic cause of jaundice. Case Report: A 46-year-old woman presented with history abdominal bloating and pelvic pain since last 3 months was found to have anemia. Clinically there was no icterus or lymphadenopathy, abdominal distension was seen but no palpable lump/hepatosplenomegly. She was non smoker/non alcoholic/ non diabetic. Laboratory findings showed Hb = 8.3 mmol/L, WBC = 8900/dl, platelet 2.28 lac/dl, creatinine 0.69 mg/dl. LFT showed normal bilirubin and albumin with raised liver enzymes, negative viral markers, normal tumor markers Ca 125, hCG, AFP & CEA. CT scan (abdomen and pelvis) done outside showed ovarian mass 7 cm  8 cm with no ascites. Rest was normal. UGI endoscopy was normal. Suspecting Ca Ovary, she was planned for NACT but due to deranged LFT she was investigated. She had no h/o NSAID use. ANA/ASMA were negative. Total Core IgG anti HBc was negative. Repeat viral markers for HAV/HEV were negative. FBS/PPBS/Lipid profile was normal. LFT’s showed AST/ALT > 3 ULN and ALP > 5 ULN. With clinical suspicion of both AIH  PBC/PSC, she underwent liver biopsy which was suggestive of early AIH. However repeat imaging was done in view of predominant cholestatic picture and MRI showed enlarged periportal metastatic nodes. Fresh tumor markers revealed a high CA125. Conclusion: In patients with known underlying malignancy, cause of uninvestigated jaundice should be considered a metastatic parenchymal liver disease and same looked for and investigated thoroughly before attributing jaundice to secondary causes.

Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S63–S73

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