J Korean Med Sci.  2017 Feb;32(2):315-320. 10.3346/jkms.2017.32.2.315.

False Positive Diagnosis of Hepatocellular Carcinoma in Liver Resection Patients

• Lee H
• Yoon JH
• Kim H
• Yi NJ
• Hong SK
• Yoon KC
• Kim HS
• Ahn SW
• Choi JY
• Choi Y
• Lee HW
• Yi JY
• Lee KB
• Lee KW
• Suh KS

• KMID: 2364177
• DOI: http://doi.org/10.3346/jkms.2017.32.2.315

Abstract

The diagnosis of hepatocellular carcinoma (HCC) is based on imaging studies particularly in high-risk patients without histologic confirmation. This study evaluated the prevalence and characteristics of false-positively diagnosed HCC in a liver resection cohort for HCC. A retrospective review was performed of 837 liver resection cases for clinically diagnosed HCC between 2005 and 2010 at our institute. High-risk patients with tumors > 1 cm with one or two image findings consistent with HCC and tumors < 1 cm with two or more image findings consistent with HCC with persistently increased serum alpha-fetoprotein (AFP) levels above the normal range with underlying inhibited hepatitis activity underwent liver resection. The false-positive rate was 2.2% (n = 18). Of the 18 patients, 7 patients (0.8%) were diagnosed with benign conditions (one each of hemangioma, inflammation, cortical adenoma, dysplastic nodule, angiomyolipoma, bile duct adenoma, and non-neoplastic liver parenchyme) and 11 patients (1.3%) were diagnosed with malignancies (cholangiocarcinoma [n = 6], hepatoblastoma [n = 2], and one each of lymphoepithelioma-like carcinoma, ovarian cystadenocarcinoma, and nasopharynx carcinoma metastasis). The clinical characteristics of pathologically diagnosed HCC patients were similar (P > 0.05) compared to non-HCC patients except for higher rate of history of alcoholism (P < 0.05) observed in non-HCC patients. Four of 18 non-HCC patients (22.2%) showed diagnostic discordance on the dynamic imaging study. Despite the recent progression in diagnostic imaging techniques, 2.2% of cases were false-positively diagnosed as HCC in a liver resection patient cohort; and the final diagnosis was benign disease in 0.8% of liver resection patients clinically diagnosed with HCC.

Keyword

Hepatocellular Carcinoma; False-positive Diagnosis; Clinical Diagnosis; Liver Resection

MeSH Terms

Adenoma
Adenoma, Bile Duct
Alcoholism
alpha-Fetoproteins
Angiomyolipoma
Carcinoma, Hepatocellular*
Cohort Studies
Cystadenocarcinoma
Diagnosis*
Diagnostic Imaging
Hemangioma
Hepatitis
Hepatoblastoma
Humans
Inflammation
Liver*
Nasopharynx
Prevalence
Reference Values
Retrospective Studies
alpha-Fetoproteins

Figure

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  Fig. 1 Patient selection in the liver resection cohort.

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  Fig. 2 Final diagnosis after liver resection for clinically diagnosed HCC.

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