Digestive disorders

I./4.3.: Diagnosis – diagnostics in addition to imaging

Imaging and histological examinations are of primary significance in the recognition of primary hepatic carcinoma. Imaging examinations used for the diagnosis depend on the size of the lesion. In case of lesions which are larger than 2 cm, the diagnosis of primary hepatic carcinoma can be established also without a biopsy, on the base of the characteristic vascular pattern demonstrated by a dynamic imaging examination. In case of lesions which are 1–2 cm large, findings of typical contrast accumulation by two dynamic imaging examinations are required for establishing the diagnosis without a biopsy. Careful monitoring of richly vascularized lesions which are smaller than 1 cm is recommended.

Sample taking for histology is recommended when the lesion is larger than 2 cm and no characteristic contrast dynamics are shown by the imaging examinations. In case of lesions which are 1–2 cm large, histological examination is recommended if the lesion shows no typical contrast dynamics or the two imaging examinations fail to produce identical results. Negative histological findings are of no excluding value. During the follow-up a repeated biopsy may be justified if the lesion is growing and it continues to be uncharacteristic with the imaging examinations.

The Barcelona Clinic Liver Cancer staging indicates recommendations for the therapy. In a very early stage (BCLC0) the lesion is at most 2 cm large, and the hepatic cirrhosis is in a balanced state (Child-Pugh A). In an early stage (BCLCA) the number of lesions is at most three and their size does not exceed 3 cm individually; the cirrhosis is in Child A–B stage. In an intermediate stage (BCLCB) the patient has one large tumor or several smaller lesions, there is no extrahepatic metastasis and the cirrhosis is of Child A–B stage. In an advanced stage (BCLCC) the extension of the tumor exceeds that of the intermediate category, and it is associated with clinical symptoms and extrahepatic propagation. In an end-stage (BCLCD) disease there is a failure of hepatic function (Child-Pugh C stage).