Evaluation of Malignant Potential for Small Hepatocellular Carcinoma Using Ultrasound B Mode

  • Dr Kosaku Moribata, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Hideyuki Tamai, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Yoshiyuki Mori, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Naoki Shingaki, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Tatsuya Shiraki, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Kimihiko Yanaoka, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Dr Masashi Oka, Second Department of Internal Medicine,Wakayama Medical University, Japan
  • Prof Masao Ichinose, Second Department of Internal Medicine,Wakayama Medical University, Japan

    • Objective: Preoperative evaluation of malignant potential is very important to determine treatment strategy for hepatocellular carcinoma(HCC). Malignant potential is so high as histological differentiation is low. The aim of the present study is to analyze the correlation between ultrasound image and pathological differentiation of small HCC.
    Methods: 113 HCC nodules that were diagnosed by biopsy or surgical resection under 3cm in size (20.5±6.3mm) were classified into two groups using ultrasound; type 1 with halo (n=27), type 2 without halo (n=86). In Addition, type 2 was categorized into three subgroups; type 2a homogenous hyperechoic (n=9), type 2b hypoechoic with smooth margin (n=35), type 2c hypoechoic with irregular or unclear margin (n=42).
    Results: The percentage of poorly differentiated HCC was 0% in type 1, 0% type 2a, 3% in type 2b, 19% in type 2c (p<0.01).The percentage of moderately differentiated HCC was 67% of type 1, 0% in type 2a, 57% in type 2b, 45% in type 2c. The percentage of well differentiated HCC was 33% in type 1, 100% in type 2a, 40% in type 2b, 36% in type 2c. Sensitivity and specificity of type 2c for the diagnosis of poorly differentiated HCC was 89% and 67%, respectively.
    Conclusions: A new classification of ultrasound for small HCC is useful for evaluation of malignant potential. Type 2c HCC is the highest grade malignancy, and next, type 1, type 2b and type 2a in order. The patients with type 2c HCC should be treated carefully.