M. Reig

Diagnóstico precoz del cáncer primario de hígado: imagen versus genética

Early diagnosis of hepatocellular carcinoma (HCC) in nodules smaller than 2 cm detected by screening ultrasounds becomes essential given that, at that stage, no vascular invasion is usually detected and treatment is associated with a high rate of long-term survival. Improvements in imaging techniques in the last few years have allowed a conclusive diagnosis of HCC in these small nodules without invasive procedures. However, a conclusive diagnosis of HCC by imaging is not always possible and, in more than half of cases, biopsy is needed. On the other hand, histological confirmation of HCC in such tiny nodules is very complex, and in most cases impossible because of the limited sample obtained. In addition, serum tumor markers currently available show low accuracy and are useless for early diagnosis. Progress in the knowledge of molecular mechanisms associated with malignant transformation will allow the use of new techniques that will facilitate diagnosis for HCC in very early stages.

Es útil la alfafetoproteína y otros marcadores en el diagnóstico y pronóstico del carcinoma hepatocelular

El carcinoma hepatocelular (CHC) es una de las neoplasias más incidentes y letales en todo el mundo y constituye la principal causa de muerte en pacientes afectos de cirrosis hepática. Existen diferentes opciones terapéuticas con capacidad curativa, pero solo son aplicables cuando se diagnostica la enfermedad en un estadio inicial. Esta es la principal justificación para realizar cribado de CHC en pacientes afectados de cirrosis1. Durante muchos años, el cribado de CHC se realizaba mediante la determinación de la alfafetoproteína (AFP). Lamentablemente, la AFP ha demostrado una baja sensibilidad y especificidad para el diagnóstico de CHC, lo que ha determinado que las principales guías científicas desaconsejen su uso como herramienta de cribado y diagnóstico2,3. Al mismo tiempo, la AFP ha demostrado en innumerables estudios una gran capacidad pronóstica, asociándose los niveles elevados de AFP a un riesgo elevado de recidiva/progresión tumoral y peor supervivencia en los diferentes estadios de la enfermedad4--8. Finalmente, en los últimos años se han identificado otros marcadores séricos que podrían superar algunas de las limitaciones descritas con la AFP. Por tanto, en el momento actual existe una gran controversia sobre la utilidad de la AFP y otros biomarcadores séricos en el manejo del CHC, tanto en el diagnóstico como en la evaluación pronóstica. Cualquier discusión sobre

Approach of the patient with a liver mass

The widespread use of imaging techniques has led to an increased diagnosis of incidental liver tumours. The differential diagnosis is extremely broad since it may range from benign asymptomatic lesions to malignant neoplasms. The correct characterisation of a liver mass has become a diagnostic challenge for most clinicians. They can be divided in two major categories; cystic lesions, usually benign with excellent long-term outcome, and solid lesions, in which malignancy should be excluded. A particular population is those patients with cirrhosis, who have high risk for hepatocellular carcinoma development. Dynamic imaging techniques have a pivotal role in the diagnostic work-up of liver tumours, allowing a confident diagnosis in most cases. If imaging is not conclusive, a biopsy should be requested to obtain a definitive diagnosis.

227 CHANGES IN TUMOR BLOOD VOLUME AND PERFUSION ASSESSED PERFUSION COMPUTED TOMOGRAPHY PREDICT THE TIMING OF TUMOR PROGRESSION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA TREATED WITH SORAFENIB

or thrombosis at any location occurred at later time points: beyond 90 days in all but 1 pt [median 306 days (37–607)]. M edian time to cardiac arrhythmia events was 43 days (11–530). The severity of CAE was mild (grade I/II) in 89 %. In 10 cases the emergence of CAE prompted treatment discontinuation. Conclusion: These data validate the efficacy and safety of pivotal trials and confirm that AHT is the most frequent, but easily manageable AE. Peripheral vascular events emerge beyond 90 days of therapy and hence, have to be intentionally screened to allow early detection and management.