Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization

Area of Science:

• Hepatobiliary radiology
• Interventional oncology
• Hepatocellular carcinoma research

Background:

• Transarterial chemoembolization (TCE) is a key treatment for unresectable hepatocellular carcinoma (HCC).
• Accurate assessment of treatment response, specifically tumor necrosis, is crucial for patient management and predicting outcomes after TCE.
• Standardized imaging criteria are needed to reliably evaluate treatment effectiveness.

Purpose of the Study:

• To correlate posttreatment imaging findings with pathologic results in patients undergoing TCE before liver transplantation or resection.
• To evaluate the predictability of necrosis using the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria on contrast-enhanced magnetic resonance imaging (CE-MRI).
• To assess the intermethod agreement between WHO and EASL criteria for evaluating treatment response.

Main Methods:

• Retrospective analysis of 35 patients who underwent TCE followed by transplantation or resection.
• Pre- and posttreatment CE-MRI were used to assess radiologic findings.
• Pathologic examination of treated lesions served as the gold standard for necrosis assessment.
• Correlation of imaging findings with pathology using Kappa (κ) statistics to determine intermethod agreement between WHO and EASL criteria.

Main Results:

• Thirty-seven percent of target lesions showed complete pathologic necrosis.
• Both EASL and WHO criteria demonstrated high specificity (≥85%) in predicting complete pathologic necrosis.
• Complete pathologic necrosis was observed in 82% of lesions classified as complete response (CR) by EASL criteria.
• Intermethod agreement between WHO and EASL criteria was minimal (κ = 0.29).

Conclusions:

• EASL and WHO imaging criteria are valuable tools for predicting pathologic necrosis following transarterial chemoembolization in HCC patients.
• Despite their predictive value for necrosis, significant discordance exists between EASL and WHO assessment methods.
• Further standardization or refinement of imaging criteria may be beneficial for consistent treatment response evaluation.