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@#Healthcare providers are responsible for performing medical check-ups, analyse and interpret patient's laboratory results. It is common for an initially asymptomatic patient to receive abnormal results including liver enzymes such as alkaline phosphatase (ALP). The concern in these patients is the cut-off value for mildly elevated levels that requires intervention. This paper reports a case of liver malignancy in a 32-year-old man who presented with a mild elevation of ALP level less than five times the upper limit of normal. The patient had no clinical symptoms. Early ultrasound liver assessment showed dilated common bile duct, which led to an urgent CT scan of the liver that revealed supportive features of fibrolamellar carcinoma. The patient was managed successfully with early partial hepatectomy that has saved him from morbidity and mortality of liver malignancy. Indeed, liver malignancy can be detected early in a health clinic from a further assessment of trivial elevation of ALP.
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INTRODUCTION@#Image-guided thermal ablation, preferably with ultrasonography (US), is increasingly used for treatment of small liver tumours. Perfluorobutane-contrast-enhanced US (pCEUS) is a promising tool that may allow for targeting of tumours that are otherwise imperceptible on greyscale US. Although pCEUS has been reported to be effective, the literature has been limited outside of Japan and South Korea. We aimed to provide data that supports the use of pCEUS in the thermal ablation of sonographically occult liver tumours.@*METHODS@#We conducted a retrospective single-centre study of 35 consecutive patients who underwent pCEUS-guided ablation of 48 liver tumours with a median size of 1.2 cm. Periprocedural, one-month post-treatment and relevant follow-up imaging studies were reviewed. Electronic records were also obtained, with long-term follow-up data of 12-28 months being available for 32 patients.@*RESULTS@#36 (75%) tumours that were imperceptible on greyscale US became visible with pCEUS. Overall, complete tumour ablation at one month was 89%. 1 (3%) patient developed a major complication following treatment, while 6 (17%) had minor post-treatment complaints. The local tumour progression rate was 17%, with a median time of 14 months.@*CONCLUSION@#pCEUS has a role in US-guided thermal ablation of liver tumours, offering a high technical success rate that is comparable to reported data. Additional benefits may include improved procedural time and freedom from ionising radiation.
ABSTRACT
In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: = 125; validation dataset, = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.
Subject(s)
Humans , Carcinoma, Hepatocellular , Diagnostic Imaging , Liver Neoplasms , Diagnostic Imaging , Magnetic Resonance Imaging , Neoplasm Grading , Methods , ROC CurveABSTRACT
To assess the diagnostic utility of glypican-3 (GPC-3) in comparison to Hep Par 1 in the diagnosis of liver tumours, a cross-sectional study involving 66 resected liver tumours were tested for the protein expression of these markers by immunohistochemistry using monoclonal antibodies. Of the 66 cases, 26 (39.4%) were hepatocellular carcinoma (HCC), 4 (6.1%) were intrahepatic cholangiocarcinoma and 36 (54.5%) were metastatic tumours. Hep Par 1 and GPC-3 expressions in HCC were 24/26 (92.3%) and 19/26 (73.1%) respectively. In contrast, of non-HCC cases, only 2/40 cases (5.0%) expressed Hep Par 1, including a metastatic colorectal adenocarcinoma and a metastatic gastric adenocarcinoma. GPC-3 was expressed in 3/40 cases (7.5%), i.e. a metastatic adenocarcinoma of unknown origin, a metastatic gastric adenocarcinoma and an intrahepatic cholangiocarcinoma. The sensitivity and specificity for Hep Par 1 were 92.3% and 95% respectively while that of GPC-3 was 73.1% and 92.5% respectively. GPC-3 is a useful marker in the diagnosis of HCC. However it is not superior to Hep Par 1 in its sensitivity and specificity. We recommend that it is utilized together with Hep Par 1 as a panel in the diagnosis of HCC.
ABSTRACT
A 55-year-old man presented with a liver mass that had been diagnosed on ultrasonography, carried out in response to the patient’s complaint of non-specific abdominal pain. Triphasic computed tomography (CT) revealed a lesion involving segments 1, 4, 5 and 8 of the liver. It was centrally hypodense with peripheral enhancement in the arterial phase suggesting a cholangiocarcinoma. The middle hepatic vein was encased and the tumour was present near the junction of the left hepatic and middle hepatic veins. We planned a right hepatic trisegmentectomy including resection of the caudate lobe but since the estimated volume of the liver remnant was only 17% of the total, we first embolised the right portal vein. CT scan repeated 5 weeks later revealed that the lesion was still resectable and that the left lateral segment had hypertrophied to 27% of the liver volume. We performed a right trisegmentectomy including caudate lobe resection using intra-operative ultrasonography to establish that the left hepatic vein was not involved. The removed lesion was hard with ill-defined margins. Histopathological examination revealed a hemangioma.
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Purpose:To study the characteristics of biological distribution in vivo and therapeutic efficacy of 125 I-anti-alpha-fetoprotein(AFP) antibody when administrated by the hepatic artery , and discussion of multi-modal therapy by transcatheter arterial chemoembolization(TACE) and immunization therapy. Methods:21 patients with moderately and advanced primary liver cancer (PLC) were treated by 125 I-anti -alpha-fetoprotein which was administered via hepatic artery, together with TACE and CD3AK cell by intravenous infusion to,detect the pharmacokinetic parameters and metabolism for 125 I-anti-AFP in vivo, and observe the efficacy of multi-modal treatment. Results:The radioactivity half-life time of ?phase (T 1/2 ?) and ? phase ( T 1/2 ?) for 125 I-anti-AFP antibodies was 1.85?1.79 and 156.46?65 hr,respectively; half-excretion time from urine was 94 hr, radiation intensity measured at body surface of organ suggested that the accumulated radioactivity was stronger and longer in the liver was than other organ.TPECT for tumour:liver ratio was 2.1?0.6. The efficacy for the treated group and the control group was respectively 61.9%(13/21) and 25.0%(5/20),the one-year cumulative survival rate of the treated group and the control group was also 61.9% and 25.0%.Conclusions: 125 I-anti-AFP via hepatic artery was able to concentrate electively in the tumour ,thereby bringing about a continuous internal irradiation for the tumour.This combined treatment is an effective method for PLC.