Rationale and Objectives
Milan criteria recommends selection of candidates with hepatocellular carcinoma (HCC) for liver transplantation based on strict tumor size thresholds. The purpose of this study is to compare the effect of two-dimensional and three-dimensional tumor measurements on the selection of candidates for liver transplantation using Milan criteria.
Materials and Methods
This retrospective Health Insurance Portability and Accountability Act–compliant study was approved by our institutional review board. Patient-informed consent was waived. Forty-five HCCs in 19 patients, evaluated with triphasic multidetector row computed tomography scans, were included in the analysis. The largest diameters in each two-dimensional orthogonal plane (Max2D) and within three-dimensional tumor boundaries (Max3D) were calculated for each lesion. Diameters were compared and the eligibility based on lesion size for liver transplantation was assessed.
Results
The mean Max2D diameter of HCC was 3.2 ± 0.9 cm and the mean Max3D diameter was 3.5 ± 1.2 cm. There was a significant difference between the mean Max2D and Max3D diameters ( P < .001). Among the 45 lesions, 22 of them (48.9%) were ineligible for transplantation according to Max2D diameter, whereas 29 of them (64.44%) were ineligible when Max3D diameter was applied ( P < .001).
Conclusion
HCC diameter based on 3D measurements is significantly different than the conventional 2D measurements and may affect eligibility for liver transplantation.
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, and its incidence has been rising in the past two decades. Curative treatments such as surgical resection and transplantation may be only indicated in patients with small tumors .
Since the beginning of the technical development of liver transplantation, nonresectable malignant lesions have been considered as a possible indication for transplantation. However, it has been recognized that patients with large, multiple, or widespread hepatocellular carcinomas with vascular invasion or extrahepatic involvement have a poor prognosis in terms of survival and recurrence, whereas patients with small, incidental tumors had the same outcome as patients transplanted for other reasons .
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Materials and methods
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Patients
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Imaging Technique
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Image Evaluation
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Statistical Analysis
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Results
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Discussion
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