Accuracy of MR Imaging and Liver Biopsy in Hepatocellular Adenomas Subtyping.
Valerie Paradis, Maxime Ronot, Stephane Bahrami, Olivier Farges, Jacques Belghiti, Pierre Bedossa, Valerie Vilgrain. Beaujon Hospital, Clichy, France; APHP, Paris, France
Background: Hepatocellular adenomas (HCAs) are divided into 4 genotype/phenotype subtypes associated with different evolutive profiles, especially regarding malignant transformation. Therefore, recognition of subtype is of clinical importance in patient management. The purpose of our study was to assess the diagnostic performance of Magnetic resonance imaging (MRI) and liver biopsy, with a special focus on the input of the immunohistochemical analysis, in a consecutive series of resected HCAs.
Design: 47 HCAs with preoperative MRI and biopsy were retrospectively included. MRI data were reviewed independently by two abdominal radiologists blind to the pathological results and classification. Subtyping of HCAs on liver biopsy was made blindly to clinical, biological, imaging data and to final classification which was obtained on the surgical specimen. Histologic subtyping was based on morphological criteria and immunohistochemistry using the 4 antibodies panel (LFABP, SAA, βcatenin and glutamin synthetase) was systematically performed when enough tissue was available (n=38).
Results: On surgical specimens, HCAs were subtyped into telangiectatic/inflammatory in 34 (72%) cases, steatotic LFABP negative in 11 (23%) cases, and 2 (4%) were unclassified (LFABP positive, SAA negative, β-catenin inactivated).Radiologists correctly classified HCAs in 85%. Interobserver Kappa correlation coefficient was .86. Routine histologic analysis led to 76.6% of correct classification and 81.6% when immunophenotypical characteristics were taken into account. Agreement between MRI findings and routine histologic analysis was observed in 74.5% leading to a likelihhod ratio of subtyping higher than 20.
Conclusions: MRI and biopsy analysis are two efficient methods in subtyping HCAs and their association increases the diagnosis confidence. Interobserver variability in MRI criteria is very low. Additional value of immunophenotypical markers is best in HCAs containing steatosis.
Category: Liver & Pancreas
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 265, Tuesday Morning