Early detection of hepatocellular carcinoma by laparoscopy: yellow nodules as diagnostic indicators

The diagnostic value in cirrhotic livers of yellow nodules undergoing fatty change was evaluated as an early indicator of hepatocellular carcinoma. Laparoscopic biopsy specimens were obtained from 22 yellow nodules in 21 patients with cirrhosis and from 1 non-cirrhotic patient. Six particular findings were recorded: at laparoscopy, (1) on the surface of the liver, the sporadic presence of yellow nodules exceeding 10 mm in diameter, or a scattering of yellow nodules smaller than 10 mm; (2) neovascularity or excessive focal vascularity; in histologic sections, (3) fatty changes; (4)"nodule-within-nodule" formation; (5) increased nuclear to cytoplasmic ratio; and (6) hypercellularity. The greater number of these findings that were observed, the more reliable was the presumed diagnosis of concomitant hepatocellular carcinoma. We conclude that the appearance of yellow nodules on the surface of the liver is a sensitive indicator of hepatocellular carcinoma and that laparoscopy thus can be of distinct value in early diagnosis.