Limited utility of routine bone scintigraphy in the staging of patients with hepatocellular carcinoma: A cross-sectional study

IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of hepatology Pub Date : 2024-08-13 DOI:10.1016/j.aohep.2024.101545
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Abstract

Introduction and Objectives

The most widely used staging system for hepatocellular carcinoma (HCC) is the Barcelona Liver Clinic Cancer (BCLC) system, which considers tumor burden, performance status, and liver function. Tumor burden is assessed with cross sectional imaging of the abdomen and chest, controversy surrounds the routine use of bone scintigraphy (BS) for detecting extrahepatic metastases. This study evaluated the role of BS in staging HCC in Mexican patients.

Patients and Methods

Retrospective cross-sectional study of all adults with HCC at a Mexican referral center from 2000 to 2018. Staging included abdominal computed tomography (CT) or magnetic resonance imaging, chest CT, and BS. The main outcome was the impact of BS on staging and/or therapy plans.

Results

Among 238 patients, 2 with fibrolamellar variant and 44 with incomplete data were excluded. Median age was 66 years, 84 % had cirrhosis, and the predominant etiology was hepatitis C virus (43 %). BCLC stages were distributed as follows: A (14 %), B (7 %), C (68 %), and D (11 %). Extrahepatic disease was present in 18 %; only 8 % patients had a positive BS. Among the positive cases, 4 were true positives, but they did not alter staging or therapy plans.

Conclusions

Routine BS in HCC staging demonstrated low yield, with a notable rate of false positives. Considering the implications of extrahepatic disease, BS may be justified for liver transplant candidates outside conventional criteria. Our study highlights the limited role of BS in early-stage HCC and advocates for a more selective utilization.

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常规骨闪烁扫描在肝细胞癌患者分期中的作用有限:一项横断面研究。
导言和目标:肝细胞癌(HCC)最广泛使用的分期系统是巴塞罗那肝脏诊所癌症(BCLC)系统,该系统考虑了肿瘤负荷、表现状态和肝功能。肿瘤负荷通过腹部和胸部的横断面成像进行评估,但围绕常规使用骨闪烁成像(BS)检测肝外转移存在争议。本研究评估了 BS 在墨西哥患者 HCC 分期中的作用:回顾性横断面研究:2000 年至 2018 年期间,墨西哥一家转诊中心对所有患有 HCC 的成人进行了研究。分期包括腹部计算机断层扫描(CT)或磁共振成像、胸部 CT 和 BS。主要结果是BS对分期和/或治疗计划的影响:在238名患者中,排除了2名纤维母细胞变异患者和44名数据不完整的患者。中位年龄为66岁,84%患有肝硬化,主要病因是丙型肝炎病毒(43%)。BCLC 分期分布如下A期(14%)、B期(7%)、C期(68%)和D期(11%)。18%的患者存在肝外疾病;只有8%的患者BS呈阳性。在阳性病例中,4 例为真阳性,但它们并没有改变分期或治疗计划:结论:HCC 分期中常规 BS 的阳性率很低,假阳性率也很高。考虑到肝外疾病的影响,对于常规标准之外的肝移植候选者,BS可能是合理的。我们的研究强调了 BS 在早期 HCC 中的有限作用,并提倡更有选择性地使用 BS。
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来源期刊
Annals of hepatology
Annals of hepatology 医学-胃肠肝病学
CiteScore
7.90
自引率
2.60%
发文量
183
审稿时长
4-8 weeks
期刊介绍: Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.
期刊最新文献
Editorial board Global multi-societies endorsement of the MAFLD definition An Acknowledgement Biological aging accelerates hepatic fibrosis: Insights from the NHANES 2017-2020 and genome-wide association study analysis. Development of a biodegradable prosthesis through tissue engineering, for the organ-replacement or substitution of the extrahepatic bile duct
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