Differences between radiology and histopathology: Are we judging correctly? Simona Onali 1 , Emmanuel Tsochatzis 1 , James O’Beirne 1 , Aileen Marshall 1 , TuVihn Luong 2 , Massimo Pinzani 1 , Pinelopi Manousou 1 1 The Royal Free Sheila Sherlock Liver Unit, Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK Department of Cellular Pathology, UCL Medical School, Royal
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Differences between radiology and histopathology: Are we judging correctly? Simona Onali 1, Emmanuel Tsochatzis 1, James O’Beirne 1, Aileen Marshall 1,
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Differences between radiology and
histopathology: Are we judging correctly?Simona Onali1, Emmanuel Tsochatzis1, James
1. To analyse any discrepancies between radiological reports and histopathological findings in the explant of patients undergoing LT for HCC
2. To identify potential factors that could predict HCC recurrence and survival post-LT between the parameters available during the pre-operative assessment period.
Patients and Methods
All consecutive patients who underwent LT for HCC between January 1997 and February 2014 at the Royal Free Hospital
Retrospectively:
- Demographic and clinical data (sex, age, aetiology of liver disease, date of LT, pre-LT HCC treatment, aFP levels)
- Pre-LT radiological findings (HCC number and size, macrovascular invasion, lymph-nodes invasion)
- Histopathological findings on explant (HCC number and size, differentiation, micro/macrovascular invasion)
- Donor characteristics
- Immunosuppression type and levels
- HCC recurrence and HCC-related death
Patients and Methods
Discrepancy between radiological and histopathological findings was assessed comparing:number of nodulessize of biggest nodule fulfilment of Milan/UCSF criteria
Patients were considered underestimated if:-nodule number and/or size was bigger on explant compared to imaging-they did not fulfil selection criteria on explant (in discordance to radiology)
They were considered overestimated when the opposite occurred.
Results: baseline patients’
characheristics (n=185)
Age median, range 55 (27-68) Gender male 150 (81%)
2. Radiological size of biggest HCCp=0.021, OR=1.04, 95% CI=1.01-1.08
Conclusions
1. Discordance between radiological and histological findings.
tumour progression between imaging and LT (tumour biology, waiting time)
innacurate imaging staging ?
Does it really matter?
Recurrence occured in 35% of underestimated patients (vs 10% of the rest) according to Milan Criteria
4 (2%) overestimated according Milan criteria: how many patients we are overestimating and not listing ?
Conclusions
2. aFP and radiological diameter of the biggest HCC were the only pre-LT factors significantly associated with HCC recurrence and HCC related survival.
• A lower aFP cut-off of 100 IU/l showed higher sensitivity than the current in identifying HCC recurrence post LT
• Combination of aFP <100 Ku/l and size of biggest HCC <30 mm seems to perform better than the actual selection criteria.
• We do propose to consider patients with diameter>30mm for LT when aFP <100 IU/L.