False Positive Diagnosis of Hepatocellular Carcinoma in Liver Resection Patients

• Published in: Journal of Korean medical science 2017, 32(2), 224, pp.315-320
• Main Authors: Lee, Hongeun, Yoon, Jeong Hee, Kim, Hyeyoung, Yi, Nam Joon, Hong, Suk Kyun, Yoon, Kyung Chul, Kim, Hyo Sin, Ahn, Sung Woo, Choi, Jin Young, Choi, Youngrok, Lee, Hae Won, Yi, Ju Yeon, Lee, Kyoung Bun, Lee, Kwang Woong, Suh, Kyung Suk
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; alpha-Fetoproteins - analysis; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Diagnostic Errors; Female; Hepatectomy; Humans; Liver - diagnostic imaging; Liver - pathology; Liver - surgery; Liver Neoplasms - diagnosis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Magnetic Resonance Imaging; Male; Middle Aged; Original; Retrospective Studies; Tomography, X-Ray Computed; Young Adult; 의학일반
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2017.32.2.315

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors < 1 cm with two or more image findings consistent with HCC with persistently increased serum alpha-fetoprotein (AFP) levels above the normal range with underlying inhibited hepatitis activity underwent liver resection. The false-positive rate was 2.2% (n = 18). Of the 18 patients, 7 patients (0.8%) were diagnosed with benign conditions (one each of hemangioma, inflammation, cortical adenoma, dysplastic nodule, angiomyolipoma, bile duct adenoma, and non-neoplastic liver parenchyme) and 11 patients (1.3%) were diagnosed with malignancies (cholangiocarcinoma [n = 6], hepatoblastoma [n = 2], and one each of lymphoepithelioma-like carcinoma, ovarian cystadenocarcinoma, and nasopharynx carcinoma metastasis). The clinical characteristics of pathologically diagnosed HCC patients were similar (P > 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.