Confronto delle linee guida internazionali per la diagnosi non invasiva del carcinoma epatocellulare: aggiornamento 2018

    Publication Date
    Source Authors
    Source Title
    Source Issue
    Publication Date

    2017

    Source Authors

    Tae-Hyung Kim, So Yeon Kim, An Tang, Jeong Min Lee

    Source Title

    Confronto delle linee guida internazionali per la diagnosi non invasiva del carcinoma epatocellulare: aggiornamento 2018

    Source Issue

    Clinical and Molecular Hepatology

    25

    Page Range: 245-263

    L’articolo redatto presenta somiglianze e differenze tra le ultime linee guida per la diagnosi non invasiva del carcinoma epatocellulare (HCC), che oggi è il carcinoma epatico più comune negli adulti e soprattutto è la seconda causa di morte nel mondo. Infatti nel 2018, le associazioni che si occupano dello studio di tale patologia hanno proposto degli importanti aggiornamenti nella diagnosi dell’HCC. Le linee guida ora includono l’imaging a risonanza magnetica (MRI) con utilizzo di mezzi di contrasto Epatospecifici come test diagnostico (non invasivo) di prima linea oltre alla TC trifasica e alla risonanza magnetica con l’uso di mezzi di contrasto extracellulari.
    L’articolo si propone di esaminare in modo esauriente gli algoritmi diagnostici e di sorveglianza dell’HCC e confrontare ed evidenziare le funzionalità chiave per ciascuna linea guida ma soprattutto anche le limitazioni di tali sistemi.
    L’epatocarcinoma (EC) è la neoplasia maligna primitiva del fegato più frequente. Nella maggioranza dei casi, l’HCC si sviluppa in un fegato cirrotico e per questo motivo i fattori di rischio per l’HCC in gran parte si sovrappongono a quelli della epatopatia cronica. In particolare, le più comuni cause di HCC in Italia (3) sono l’epatite C (49%), seguita dall’abuso alcolico (21%), dall’epatite virale associata al consumo alcolico (12%), e dall’epatite B (13%). Una diagnosi precoce può far attuare dei protocolli terapeutici fondamentali per la vita del paziente ( Resezione chirurgica, trapianto, trattamenti di ablazione).
    L’originalità del lavoro risiede nell’esaltare e sottolineare che una diagnosi precoce e un intervento tempestivo possono essere cruciali nel trattamento di un paziente. Per questo motivo l’imaging diagnostico non invasivo (RM con MDC e TC con MDC) svolge un ruolo fondamentale nella gestione del paziente con HCC. Lo scopo di questo articolo di revisione è di sintetizzare e criticamente valutare i sistemi diagnostici basati sull’imaging attualmente pubblicati approvati dalle cinque principali società per la diagnosi non invasiva di HCC e per affrontare alcune limitazioni degli attuali sistemi.
    L’articolo si suddivide in vari punti. Nella prima parte si sofferma sulla spiegazione della patologia e sulla sua diffusione. Nella seconda parte l’articolo si sofferma sulle linee guida che sono state continuamente aggiornate per riflettere i più recenti progressi radiologici e tecnologici, nonché la migliore comprensione della patofisiologia dell’HCC. L’imaging diagnostico non invasivo svolge un ruolo fondamentale nella sorveglianza, diagnosi precoce, stadiazione , trattamento e monitoraggio del tratamento.

    BIBLIOGRAFIA

    1.Choo SP, Tan WL, Goh BKP, Tai WM, Zhu AX. Comparison of hepatocellular carcinoma in Eastern versus Western populations. Cancer 2016;122:3430-3446.

    2.Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S, Ahmed M, Alam N, Alemayohu MA, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015. JAMA Oncol 2017;3:1683-1691.

    3.Shields A, Reddy KR. Hepatocellular carcinoma: current treatment strategies. Curr Treat Options Gastroenterol 2005;8:457-466.

    4.Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67:358-380.

    5.Tang A, Cruite I, Mitchell DG, Sirlin CB. Hepatocellular carcinoma imaging systems: why they exist, how they have evolved, and how they differ. Abdom Radiol (NY) 2018;43:3-12.

    6.Tang A, Cruite I, Sirlin CB. Toward a standardized system for hepato- cellular carcinoma diagnosis using computed tomography and MRI. Expert Rev Gastroenterol Hepatol 2013;7:269-279.

    7.Gavriilidis P, Roberts KJ, Askari A, Sutcliffe RP, Huo TL, Liu PH, et al. Evaluation of the current guidelines for resection of hepatocellular carcinoma using the Appraisal of Guidelines for Research and Evaluation II instrument. J Hepatol 2017;67:991-998.

    8.Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia- Pacific clinical practice guidelines on the management of hepatocel- lular carcinoma: a 2017 update. Hepatol Int 2017;11:317-370.

    9.American College of Radiology (ACR). Liver Imaging Reporting and Data System version 2017. ACR web site, <https://www.acr.org/ Quality-Safety/Resources/LIRADS/LIRADS-v2017>. Accessed 31 Oct 2018.

    10.American College of Radiology (ACR). Liver Imaging Reporting and Data System version 2018. ACR web site, <https://www.acr.org/ Clinical-Resources/Reporting-and-Data-Systems/LI-RADS>. Accessed 31 Oct 2018.

    11.Marrero JA, Kulik LM, Sirlin C, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2018;68:723-750.

    12.European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182-236.

    13.Korean Liver Cancer Association-National Cancer Center (KLCA- NCC). 2018 KLCA-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma. KLCA-NCC web site, <http:// livercancer.or.kr/study/guidelines.php>. Accessed 31 Oct 2018.

    14.Cruite I, Tang A, Sirlin CB. Imaging-based diagnostic systems for hepatocellular carcinoma. AJR Am J Roentgenol 2013;201:41-55.

    15.American College of Radiology (ACR). Ultrasound LI-RADS(R) v2017. ACR web site, <https://www.acr.org/Clinical-Resources/Reporting- and-Data-Systems/LI-RADS/Ultrasound-LI-RADS-v2017>. Accessed 31 Oct 2018.

    16.Dulku G, Dhillon R, Goodwin M, Cheng W, Kontorinis N, Mendelson R. The role of imaging in the surveillance and diagnosis of hepato- cellular cancer. J Med Imaging Radiat Oncol 2017;61:171-179.

    17.Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009;30:37-47.

    18.Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis. Gastroenterology 2018;154:1706-1718.e1.

     19.Chernyak V, Santillan CS, Papadatos D, Sirlin CB. LI-RADS(R) algo- rithm: CT and MRI. Abdom Radiol (NY) 2018;43:111-126.

    20.Kitao A, Matsui O, Yoneda N, Kozaka K, Shinmura R, Koda W, et al. The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid en- hanced MR imaging. Eur Radiol 2011;21:2056-2066.

    21.Kogita S, Imai Y, Okada M, Kim T, Onishi H, Takamura M, et al. Gd- EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol 2010;20:2405-2413.

    22.Lee YJ, Lee JM, Lee JS, Lee HY, Park BH, Kim YH, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging a systematic review and meta-analysis. Radiology 2015;275:97-109.

    23.Kim TK, Noh SY, Wilson SR, Kono Y, Piscaglia F, Jang HJ, et al. Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 – a review of important differences compared to the CT/MRI system. Clin Mol Hepatol 2017;23:280- 289.

    24.Leoni S, Piscaglia F, Granito A, Borghi A, Galassi M, Marinelli S, et al. Characterization of primary and recurrent nodules in liver cirrhosis using contrast-enhanced ultrasound: which vascular criteria should be adopted? Ultraschall Med 2013;34:280-287.

    25.Furlan A, Marin D, Cabassa P, Taibbi A, Brunelli E, Agnello F, et al. Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI: intermodality agree- ment and comparison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines. Eur J Radiol 2012;81:2099-2105.

    26.Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospec- tive validation of the noninvasive diagnostic criteria for hepatocel- lular carcinoma. Hepatology 2008;47:97-104.

    27.Piscaglia F, Kudo M, Han KH, Sirlin C. Diagnosis of hepatocellular carcinoma with non-invasive imaging: a plea for worldwide adop- tion of standard and precise terminology for describing enhance- ment criteria. Ultraschall Med 2017;38:9-11.

    28.Piscaglia F, Wilson SR, Lyshchik A, Cosgrove D, Dietrich CF, Jang HJ, et al. American College of Radiology Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for the diagnosis of hepatocellular carcinoma: a pictorial essay. Ultraschall Med 2017;38:320-324.

    29.Chen LD, Xu HX, Xie XY, Xie XH, Xu ZF, Liu GJ, et al. Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diag- nosis with contrast-enhanced ultrasound. Eur Radiol 2010;20:743- 753.

    30.Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013;34:11-29.

    31.Wildner D, Bernatik T, Greis C, Seitz K, Neurath MF, Strobel D. CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carci- noma in 320 patients – early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall Med 2015;36:132-139.

    32.Wildner D, Pfeifer L, Goertz RS, Bernatik T, Sturm J, Neurath MF, et al. Dynamic contrast-enhanced ultrasound (DCE-US) for the charac- terization of hepatocellular carcinoma and cholangiocellular carci- noma. Ultraschall Med 2014;35:522-527.

    33.Terzi E, Iavarone M, Pompili M, Veronese L, Cabibbo G, Fraquelli M, et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. J Hepatol 2018;68:485-492.

    34.Aubé C, Oberti F, Lonjon J, Pageaux G, Seror O, N’Kontchou G, et al. EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice. Liver Int 2017;37:1515-1525.

    35.Bota S, Piscaglia F, Marinelli S, Pecorelli A, Terzi E, Bolondi L. Com- parison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma. Liver Cancer 2012;1:190-200.

    36.Kudo M. Defect reperfusion imaging with Sonazoid(R): a break- through in hepatocellular carcinoma. Liver Cancer 2016;5:1-7.

    37.Jang HJ, Kim TK, Burns PN, Wilson SR. CEUS: an essential compo- nent in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma. Eur J Radiol 2015;84:1623- 1635.

    38.Farinati F, Sergio A, Baldan A, Giacomin A, Di Nolfo MA, Del Pog- gio P, et al. Early and very early hepatocellular carcinoma: when and how much do staging and choice of treatment really matter? A multi-center study. BMC Cancer 2009;9:33.

    39.Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standard- ization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 2013;266:376-382.

    40.Joo I, Lee JM, Lee DH, Jeon JH, Han JK, Choi BI. Noninvasive diag- nosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alterna- tive to washout? Eur Radiol 2015;25:2859-2868.

    41.Choi SH, Byun JH, Lim YS, Yu E, Lee SJ, Kim SY, et al. Diagnos- tic criteria for hepatocellular carcinoma 3 cm with hepatocyte- specific contrast-enhanced magnetic resonance imaging. J Hepatol 2016;64:1099-1107.

    42.Kierans AS, Kang SK, Rosenkrantz AB. The diagnostic performance of dynamic contrast-enhanced MR imaging for detection of small hepatocellular carcinoma measuring up to 2 cm: a meta-analysis. Radiology 2016;278:82-94.

    43.Joo I, Lee JM, Lee DH, Jeon JH, Han JK. Retrospective validation of a new diagnostic criterion for hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout with the aid of ancillary features? Eur Radiol 2019;29:1724-1732.

    44.Maruyama H, Sekimoto T, Yokosuka O. Role of contrast-enhanced ultrasonography with Sonazoid for hepatocellular carcinoma: evi- dence from a 10-year experience. J Gastroenterol 2016;51:421-433.

    45.Hatanaka K, Kudo M, Minami Y, Maekawa K. Sonazoid-enhanced ultrasonography for diagnosis of hepatic malignancies: comparison with contrast-enhanced CT. Oncology 2008;75 Suppl 1:42-47.

    46.Liu W, Qin J, Guo R, Xie S, Jiang H, Wang X, et al. Accuracy of the diagnostic evaluation of hepatocellular carcinoma with LI-RADS. Acta Radiol 2018;59:140-146.

    47.Kim YY, An C, Kim S, Kim MJ. Diagnostic accuracy of prospective ap- plication of the Liver Imaging Reporting and Data System (LI-RADS) in gadoxetate-enhanced MRI. Eur Radiol 2018;28:2038-2046.

    48.Abd Alkhalik Basha M, Abd El Aziz El Sammak D, El Sammak AA. Diagnostic efficacy of the Liver Imaging-Reporting and Data System (LI-RADS) with CT imaging in categorising small nodules (10-20 mm) detected in the cirrhotic liver at screening ultrasound. Clin Ra- diol 2017;72:901.e1-901.e11.

    49.Sofue K, Burke LMB, Nilmini V, Alagiyawanna M, Muir AJ, Choud- hury KR, et al. Liver imaging reporting and data system category 4 observations in MRI: risk factors predicting upgrade to category 5. J Magn Reson Imaging 2017;46:783-792.

    50.Tanabe M, Kanki A, Wolfson T, Costa EA, Mamidipalli A, Ferreira MP, et al. Imaging outcomes of liver imaging reporting and data system version 2014 category 2, 3, and 4 observations detected at CT and MR imaging. Radiology 2016;281:129-139.

    51.Burke LM, Sofue K, Alagiyawanna M, Nilmini V, Muir AJ, Choudhury KR, et al. Natural history of liver imaging reporting and data system category 4 nodules in MRI. Abdom Radiol (NY) 2016;41:1758-1766.

    52.Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocel- lular carcinoma. Hepatology 2005;42:1208-1236.

    53.Zhang J, Yu Y, Li Y, Wei L. Diagnostic value of contrast-enhanced ul- trasound in hepatocellular carcinoma: a meta-analysis with evidence from 1998 to 2016. Oncotarget 2017;8:75418-75426.

    54.Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology 2015;61:1056-1065.

    55.Jang KM, Kim SH, Kim YK, Choi D. Imaging features of subcentime- ter hypointense nodules on gadoxetic acid-enhanced hepatobiliary phase MR imaging that progress to hypervascular hepatocel- lular carcinoma in patients with chronic liver disease. Acta Radiol 2015;56:526-535.

     56.Song KD, Kim SH, Lim HK, Jung SH, Sohn I, Kim HS. Subcentimeter hypervascular nodule with typical imaging findings of hepatocel- lular carcinoma in patients with history of hepatocellular carcinoma: natural course on serial gadoxetic acid-enhanced MRI and diffusion- weighted imaging. Eur Radiol 2015;25:2789-2796.

    57.Wang JH, Changchien CS, Hu TH, Lee CM, Kee KM, Lin CY, et al. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma Survival analysis of 3892 patients. Eur J Cancer 2008;44:1000-1006.

    58.Joo I, Lee JM. Recent advances in the imaging diagnosis of hepa-tocellular carcinoma: value of gadoxetic acid-enhanced MRI. Liver Cancer 2016;5:67-87.