DIAGNOSIS AND CLINICAL-FEATURES OF SMALL HEPATOCELLULAR-CARCINOMA WITH EMPHASIS ON THE UTILITY OF REAL-TIME ULTRASONOGRAPHY - A STUDY IN 51 PATIENTS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 86  (3) , 495-502
Abstract
The clinical features and usefulness of various methods for diagnosis of small hepatocellular carcinoma, no greater than 5 cm in diameter, were studied in 51 patients. The diagnosis was verified in 28 patients by hepatic resection and in 4 patients at autopsy. The tumor was < 3 cm in diameter in 23 patients. In 37 patients (72.5%), the tumor was first discovered by real-time linear scan ultrasonography, generally during a routine periodic follow-up examination of patients with chronic liver disease, mostly cirrhosis. Clinically, 62.7% of the patients were asymptomatic, and symptoms in the remainder were not suggestive of carcinoma. Most patients showed only mildly abnormal liver function tests that did not suggest the diagnosis. Serum .alpha.-fetoprotein level was normal in 25.5%, and it was elevated above 200 ng/ml in only 33.3%. Among the various imaging modalities, ultrasonography had the highest detection rate (92.2%) for these small hepatocellular carcinomas compared with computed tomography (73.2%), scintigraphy (50.0%) and angiography (86.0%). False-positive lesions, however, were also found frequently by ultrasonography, requiring ultrasonography-guided biopsy for differential diagnosis in some of the patients. Routine examination at regular intervals of patients with chronic liver disease using a combination of realtime ultrasonography and .alpha.-fetoprotein measurement is currently the most effective approach to detecting small hepatocellular carcinoma.