[Detection of neoplastic lesions in cirrhotic patients waiting for liver transplantation]. / Detección de lesiones neoplásicas en pacientes cirróticos candidatos a trasplante hepático.

INTRODUCTION: Hepatocellular carcinoma is a frequent complication of cirrhosis. Liver transplantation is a valid therapeutic option for this disease providing that certain morphologic selection criteria (Milan criteria) are fulfilled. OBJECTIVE: To evaluate the accuracy of pretransplantation imaging examinations in the detection and characterization of neoplastic lesions in cirrhotic candidates for liver transplantation. PATIENTS AND METHOD: We performed a retrospective study of 250 cirrhotic patients who underwent liver transplantation. The preoperative radiological diagnosis was compared with the definitive pathological diagnosis, allowing the diagnostic sensitivity of the different techniques, as well as the degree of agreement between pre- and postoperative tumoral staging, to be identified. RESULTS: Analysis of 250 specimens from total hepatectomy identified 58 patients with hepatic tumors, with a total of 136 nodules. Fifty-three patients had hepatocarcinoma, nine of which were found incidentally. There were six radiological false positive diagnoses. Sixty-two percent of patients with hepatocarcinoma had multiple lesions. The most sensitive technique for the diagnosis of tumors smaller than 1 cm was magnetic resonance imaging. Agreement between pre- and postoperative staging was found in only 63.6% of cases; consequently, 43% of the patients who exceeded the Milan criteria (20% stage T3 and 23% stage T4a) underwent transplantation. CONCLUSIONS: Currently used imaging techniques lead to a substantial proportion of incorrect stagings in terms of the size and number of lesions in cirrhotic patients.

Detección de lesiones neoplásicas en pacientes cirróticos candidatos a trasplante hepático / Detection of neoplastic lesions in cirrhotic patients waiting for liver transplantation

Introducción. El hepatocarcinoma es una complicación frecuente de la cirrosis. El trasplante hepático es una opción terapéutica válida para esta enfermedad siempre que se cumplan unos criterios morfológicos de selección (criterios de Milán). Objetivo. Valorar la eficacia de las pruebas de imagen en la detección y caracterización preoperatoria de lesiones neoplásicas en pacientes cirróticos candidatos a trasplante hepático. Pacientes y método. Estudio retrospectivo de 250 pacientes cirróticos trasplantados, en el que se compara el diagnóstico radiológico preoperatorio con el anatomopatológico definitivo, lo que permite conocer la sensibilidad diagnóstica de las diferentes pruebas, así como identificar el grado de concordancia entre la estadificación tumoral preoperatoria y la postoperatoria. Resultados. El estudio de las 250 piezas de hepatectomía total permitió identificar a 58 pacientes con tumor hepático, con un total de 136 nódulos tumorales. En 53 casos se trataba de hepatocarcinomas, 9 de los cuales fueron incidentales. Hubo 6 casos falsos positivos radiológicos. Los pacientes con hepatocarcinoma presentaban lesiones múltiples en el 62% de los casos. La resonancia magnética fue la técnica más sensible para el diagnóstico de lesiones menores de 1 cm. Sólo hubo concordancia entre la estadificación preoperatoria y la postoperatoria en el 63,6% de los casos, y ello condicionó que hubiera un 43% de pacientes que fueron trasplantados superando los criterios de Milán (el 20% en estadio T3 y el 23% en estadio T4a). Conclusiones. Las técnicas de imagen presentan un importante porcentaje de incorrecta estadificación en cuanto al diagnóstico del tamaño y el número de lesiones tumorales (AU)

Introduction. Hepatocellular carcinoma is a frequent complication of cirrhosis. Liver transplantation is a valid therapeutic option for this disease providing that certain morphologic selection criteria (Milan criteria) are fulfilled. Objective. To evaluate the accuracy of pretransplantation imaging examinations in the detection and characterization of neoplastic lesions in cirrhotic candidates for liver transplantation. Patients and method. We performed a retrospective study of 250 cirrhotic patients who underwent liver transplantation. The preoperative radiological diagnosis was compared with the definitive pathological diagnosis, allowing the diagnostic sensitivity of the different techniques, as well as the degree of agreement between pre- and postoperative tumoral staging, to be identified. Results. Analysis of 250 specimens from total hepatectomy identified 58 patients with hepatic tumors, with a total of 136 nodules. Fifty-three patients had hepatocarcinoma, nine of which were found incidentally. There were six radiological false positive diagnoses. Sixty-two percent of patients with hepatocarcinoma had multiple lesions. The most sensitive technique for the diagnosis of tumors smaller than 1 cm was magnetic resonance imaging. Agreement between pre- and postoperative staging was found in only 63.6% of cases; consequently, 43% of the patients who exceeded the Milan criteria (20% stage T3 and 23% stage T4a) underwent transplantation. Conclusions. Currently used imaging techniques lead to a substantial proportion of incorrect stagings in terms of the size and number of lesions in cirrhotic patients (AU)