[Detection of neoplastic lesions in cirrhotic patients waiting for liver transplantation]

Hepatocellular carcinoma is a frequent complication of cirrhosis. Liver transplantation is a valid therapeutic option for this disease providing that certain morphologic selection criteria (Milan criteria) are fulfilled.

To evaluate the accuracy of pretransplantation imaging examinations in the detection and characterization of neoplastic lesions in cirrhotic candidates for liver transplantation.

We performed a retrospective study of 250 cirrhotic patients who underwent liver transplantation. The preoperative radiological diagnosis was compared with the definitive pathological diagnosis, allowing the diagnostic sensitivity of the different techniques, as well as the degree of agreement between pre- and postoperative tumoral staging, to be identified.

Analysis of 250 specimens from total hepatectomy identified 58 patients with hepatic tumors, with a total of 136 nodules. Fifty-three patients had hepatocarcinoma, nine of which were found incidentally. There were six radiological false positive diagnoses. Sixty-two percent of patients with hepatocarcinoma had multiple lesions. The most sensitive technique for the diagnosis of tumors smaller than 1 cm was magnetic resonance imaging. Agreement between pre- and postoperative staging was found in only 63.6% of cases; consequently, 43% of the patients who exceeded the Milan criteria (20% stage T3 and 23% stage T4a) underwent transplantation.

Currently used imaging techniques lead to a substantial proportion of incorrect stagings in terms of the size and number of lesions in cirrhotic patients.