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Combining imaging and tumour biopsy improves the diagnosis of combined hepatocellular-cholangiocarcinoma.

Authors
  • Gigante, Elia1, 2
  • Ronot, Maxime3
  • Bertin, Caroline3
  • Ciolina, Maria3
  • Bouattour, Mohamed4
  • Dondero, Federica5
  • Cauchy, François2, 5
  • Soubrane, Olivier5
  • Vilgrain, Valérie3
  • Paradis, Valérie2, 6
  • 1 Department of Hepatology, Saint-Antoine Hospital, APHP, Paris, France. , (France)
  • 2 INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France. , (France)
  • 3 Department of Radiology, Beaujon Hospital, APHP, Clichy, France. , (France)
  • 4 Department of Digestive Oncology, Beaujon Hospital, APHP, Clichy, France. , (France)
  • 5 Department of Hepatobiliary Surgery, Beaujon Hospital, APHP, Clichy, France. , (France)
  • 6 Department of Pathology, Beaujon Hospital, APHP, Clichy, France. , (France)
Type
Published Article
Journal
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Dec 01, 2019
Volume
39
Issue
12
Pages
2386–2396
Identifiers
DOI: 10.1111/liv.14261
PMID: 31544304
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is by definition a highly heterogeneous tumour, which significantly impacts its diagnosis. The aim of the study was to evaluate the diagnostic performance of imaging using computed tomography and/or magnetic resonance (MR) and biopsy for the diagnosis of cHCC-CCA. cHCC-CCA resected between December 2006 and April 2017 with available pre-operative imaging and tumour biopsy were retrospectively included. cHCC-CCA diagnosis was based on morphological and immunophenotypical features. A total of 21 cHCC-CCA were compared to 21 intrahepatic cholangiocarcinoma (iCCA) as controls. All biopsies were reviewed. Two radiologists reviewed the cases and classified tumours into four patterns (type 1 [progressive enhancement of the entire lesion, iCCA type], type 2 [arterial enhancement with washout, HCC type], type 3 [mixed pattern with combinations of 1, 2 and 4] and type 4 [atypical pattern, areas of arterial enhancement without washout and/or hypovascular]). The presence of a type 3 pattern at imaging had a 48% sensitivity and 81% specificity for cHCC-CCA diagnosis. The initial diagnosis performed on biopsy was cHCC-CCA in 8/21 patients (38%). After reviewing and including immunophenotypical markers, two more cases were diagnosed as cHCC-CCA (48% sensibility, 100% specificity). When either imaging or biopsy suggested the diagnosis of cHCC-CCA, the sensitivity and specificity were 60% and 82% respectively. We showed that a two-step strategy combining imaging as the first step and biopsy as the second step improved the diagnostic performance of cHCC-CCA. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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