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Laboratory Tests and Ancillaries
Liver Biopsy (Core
Needle Biopsy)
Hepatocellular Carcinoma_DiganosticsLiver biopsy is indicated in patients with conditions associated with the formation of non-malignant nodules (eg cardiac cirrhosis, congenital hepatic fibrosis or cirrhosis due to a vascular disorder [eg Budd-Chiari syndrome, hereditary telangiectasia]) that may be confused with hepatocellular carcinoma during imaging. Optimal diagnostic procedure if there is suspicion of malignancy in the lesion but multiphasic computed tomography or magnetic resonance imaging results do not meet imaging criteria for hepatocellular carcinoma. This may be done in patients who are not considered high risk for developing hepatocellular carcinoma. This is considered in patients with elevated CA 19-9 or carcinoembryonic antigen (CEA) in order to rule out intrahepatic cholangiocarcinoma or for confirmation of metastatic disease. This should be strongly considered in patients with more advanced stages of hepatocellular carcinoma and suitable for systemic therapy. This should be done before ablation when possible.
Serum Biomarkers
Examples of serum biomarkers are des-gamma-carboxy prothrombin (DCP) or protein induced by vitamin K absence or antagonist-II (PIVKA-II) and lens culinaris agglutinin-reactive AFP (AFP-L3) which is an isoform of alpha fetoprotein.
Imaging
Diagnostic Methods
4-Phase Multidetector Computed Tomography
(MDCT)/Contrast-enhanced Dynamic Magnetic
Resonance Imaging (MRI)
4-Phase multidetector computed
tomography/contrast-enhanced dynamic magnetic resonance imaging is the primary
diagnostic examination of hepatocellular carcinoma using extracellular contrast
agents. Diagnostic imaging characteristics are the presence of arterial phase
hypervascularity, non-peripheral venous or delayed venous phase wash-out,
enhanced capsule appearance and threshold growth. This is recommended in
patients with high clinical suspicion of hepatocellular carcinoma (eg after
identification of a liver nodule on ultrasound or rising serum alpha
fetoprotein level) and with known risk factors for hepatocellular carcinoma.
This is more sensitive than ultrasound for detection of hepatocellular
carcinoma but is more expensive. For extrahepatic staging, contrast-enhanced computed
tomography or magnetic resonance imaging of the abdomen and pelvis is
recommended during initial diagnosis, disease monitoring, and treatment
monitoring.