Synchronous multicentric small hepatocellular carcinomas: defining the capsule on high-frequency intraoperative...

Area of Science:

• Hepatobiliary Surgery
• Diagnostic Imaging
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a common primary liver cancer.
• Multicentric HCC involves multiple distinct tumor foci within the liver.
• Accurate characterization of HCC nodules is crucial for surgical planning and prognosis.

Purpose of the Study:

• To define the capsules of synchronous multicentric small hepatocellular carcinomas (HCCs).
• To evaluate the utility of high-frequency intraoperative ultrasonography (IOUS) in visualizing these capsules.

Main Methods:

• Retrospective analysis of 131 patients undergoing hepatic resection for HCC.
• Inclusion of 16 synchronous multicentric small HCCs from 13 patients.
• Comparison of high-frequency IOUS findings with histopathological examination of resected specimens, focusing on capsule characteristics.

Main Results:

• Synchronous multicentric small HCCs were classified as distinctly nodular (n=12) or vaguely nodular (n=4).
• All 12 distinctly nodular HCCs, including six subcentimeter lesions, exhibited detectable capsules on high-frequency IOUS and pathology.
• Capsules displayed varied echogenicity (hypoechoic rim with foci, hypoechoic rim, hyperechoic rim) and coverage, composed histologically of fibrous tissue, fibrosis, vessels, and entrapped parenchyma.

Conclusions:

• Distinctly nodular synchronous multicentric small HCCs, even when subcentimeter, possess identifiable capsules.
• High-frequency IOUS can visualize these capsules, demonstrating diverse echogenicity and coverage.
• Capsule visualization aids in the characterization of small HCCs during surgery.