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9 results on '"Vavassori S."'

1. Imaging of combined hepatocellular-cholangiocarcinoma in cirrhosis and risk of false diagnosis of hepatocellular carcinoma.

Author

Sagrini E, Iavarone M, Stefanini F, Tovoli F, Vavassori S, Maggioni M, Renzulli M, Salvatore V, Stefanescu H, Colombo M, Bolondi L, and Piscaglia F

Subjects
Adult, Aged, Bile Duct Neoplasms etiology, Biomarkers, Carcinoma, Hepatocellular etiology, Cholangiocarcinoma etiology, Diagnostic Errors, Female, Humans, Image Enhancement, Liver Cirrhosis complications, Liver Neoplasms etiology, Magnetic Resonance Imaging methods, Magnetic Resonance Imaging standards, Male, Middle Aged, Multimodal Imaging methods, Multimodal Imaging standards, Risk Factors, Tomography, X-Ray Computed methods, Tomography, X-Ray Computed standards, Tumor Burden, Ultrasonography methods, Ultrasonography standards, Bile Duct Neoplasms diagnostic imaging, Carcinoma, Hepatocellular diagnostic imaging, Cholangiocarcinoma diagnostic imaging, Liver Cirrhosis diagnostic imaging, Liver Neoplasms diagnostic imaging
Abstract

Background: Diagnosis of hepatocellular carcinoma can be achieved by imaging in cirrhotic patients. Combined hepatocellular-cholangiocarcinoma is a primary liver tumor and its imaging patterns have been poorly investigated. Misdiagnosis for either hepatocellular carcinoma or benign lesions can occur. We aimed to evaluate the enhancement pattern of combined hepatocellular-cholangiocarcinoma in cirrhosis with imaging techniques and to estimate the risk of misdiagnosis for hepatocellular carcinoma., Methods: All histology-confirmed combined hepatocellular-cholangiocarcinoma in cirrhosis seen in two Italian centers between 2003 and 2016, in which at least one imaging technique had been performed, was retrospectively collected. The enhancement pattern was analyzed for all available imaging modalities., Results: A total of 37 combined hepatocellular-cholangiocarcinoma nodules were identified. Contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging had been performed in 27, 34, and 17 nodules, respectively. Contrast-enhanced ultrasound was at higher risk of misdiagnosis for pure hepatocellular carcinoma than computed tomography ( p  = 0.005) or magnetic resonance imaging ( p  = 0.040). Only six of 24 combined hepatocellular-cholangiocarcinoma lesions submitted to both contrast-enhanced ultrasound and computed tomography showed coincident patterns; contrast-enhanced ultrasound correctly suggested a condition of malignancy in a higher number of cases than computed tomography ( p  < 0.001) and magnetic resonance imaging ( p  = 0.002)., Conclusions: Contrast-enhanced ultrasound misdiagnosed a higher number of combined hepatocellular-cholangiocarcinoma as hepatocellular carcinoma than computed tomography and magnetic resonance imaging. However, the latter techniques were able to identify features of malignancy less often.

Published
2019
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2. Predictors of survival in patients with advanced hepatocellular carcinoma who permanently discontinued sorafenib.

Author

Iavarone M, Cabibbo G, Biolato M, Della Corte C, Maida M, Barbara M, Basso M, Vavassori S, Craxì A, Grieco A, Cammà C, and Colombo M

Subjects
Aged, Analysis of Variance, Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Cohort Studies, Female, Humans, Italy, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness pathology, Neoplasm Staging, Niacinamide administration & dosage, Niacinamide adverse effects, Patient Selection, Phenylurea Compounds adverse effects, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Risk Assessment, Sorafenib, Survival Analysis, Carcinoma, Hepatocellular drug therapy, Drug-Related Side Effects and Adverse Reactions epidemiology, Liver Neoplasms drug therapy, Niacinamide analogs & derivatives, Phenylurea Compounds administration & dosage, Withholding Treatment statistics & numerical data
Abstract

Unlabelled: Treatment with sorafenib of patients with advanced hepatocellular carcinoma is challenged by anticipated discontinuation due to tumor progression, liver decompensation, or adverse effects. While postprogression survival is clearly determined by the pattern of tumor progression, understanding the factors that drive prognosis in patients who discontinued sorafenib for any reason may help to improve patient management and second-line trial design. Patients consecutively admitted to three referral centers who were receiving best supportive care following permanent discontinuation of sorafenib for any reason were included. Postsorafenib survival (PSS) was calculated from the last day of treatment to death or last visit available. Two hundred and sixty patients were included in this prospective study, aged 67 years, 60% with hepatitis C, 51% Child-Pugh A, 83% performance status (PS) ≥1, 41% with macroscopic vascular invasion, and 38% with extrahepatic tumor spread. Overall, median PSS was 4.1 (3.3-4.9) months, resulting from 4.6 (3.3-5.7) months for 123 progressors, 7.3 (6.0-10.0) months in 77 with adverse effects, and 1.8 (1.6-2.4) months in 60 decompensated patients (P < 0.001). Postsorafenib survival was independently predicted by PS, prothrombin time, extrahepatic tumor spread, macrovascular invasion, and reason for discontinuation. Two hundred patients potentially eligible for second-line therapy had a PSS of 5.3 (4.6-7.1) months, which was dependent on reasons of discontinuation (P = 0.004), PS (P < 0.001), macrovascular invasion (P < 0.001), and extrahepatic metastases (P < 0.002)., Conclusion: Discontinuation due to adverse effects in the absence of macrovascular invasion, extrahepatic metastases, and deteriorated PS predicts the best PSS in compensated patients, thereby setting the stage for both improved patient counseling and selection for second-line therapy., (© 2015 by the American Association for the Study of Liver Diseases.)

Published
2015
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3. VEGF and VEGFR genotyping in the prediction of clinical outcome for HCC patients receiving sorafenib: the ALICE-1 study.

Author

Scartozzi M, Faloppi L, Svegliati Baroni G, Loretelli C, Piscaglia F, Iavarone M, Toniutto P, Fava G, De Minicis S, Mandolesi A, Bianconi M, Giampieri R, Granito A, Facchetti F, Bitetto D, Marinelli S, Venerandi L, Vavassori S, Gemini S, D'Errico A, Colombo M, Bolondi L, Bearzi I, Benedetti A, and Cascinu S

Subjects
Adult, Aged, Antineoplastic Agents therapeutic use, Carcinoma, Hepatocellular mortality, Cell Proliferation drug effects, Disease-Free Survival, Female, Genotype, Humans, Liver Neoplasms mortality, Lymphangiogenesis drug effects, Male, Middle Aged, Neovascularization, Pathologic drug therapy, Niacinamide therapeutic use, Polymorphism, Single Nucleotide, Protein Kinase Inhibitors therapeutic use, Retrospective Studies, Sorafenib, Treatment Outcome, Vascular Endothelial Growth Factor C genetics, Vascular Endothelial Growth Factor Receptor-2 genetics, Vascular Endothelial Growth Factor Receptor-3 genetics, Carcinoma, Hepatocellular drug therapy, Drug Resistance, Neoplasm genetics, Liver Neoplasms drug therapy, Niacinamide analogs & derivatives, Phenylurea Compounds therapeutic use, Vascular Endothelial Growth Factor A antagonists & inhibitors, Vascular Endothelial Growth Factor A genetics, Vascular Endothelial Growth Factor Receptor-1 genetics
Abstract

Although new treatment modalities changed the global approach to hepatocellular carcinoma (HCC), this disease still represents a medical challenge. Currently, the therapeutic stronghold is sorafenib, a tyrosine kinase inhibitor (TKI) directed against the vascular endothelial growth factor (VEGF) family. Previous observations suggested that polymorphisms of VEGF and its receptor (VEGFR) genes may regulate angiogenesis and lymphangiogenesis and thus tumour growth control. The aim of our study was to evaluate the role of VEGF and VEGFR polymorphisms in determining the clinical outcome of HCC patients receiving sorafenib. From a multicentre experience 148 samples (tumour or blood samples) of HCC patients receiving sorafenib were tested for VEGF-A, VEGF-C and VEGFR-1,2,3 single nucleotide polymorphisms (SNPs). Patients' progression-free survival (PFS) and overall survival (OS) were analysed. At univariate analysis VEGF-A alleles C of rs25648, T of rs833061, C of rs699947, C of rs2010963, VEGF-C alleles T of rs4604006, G of rs664393, VEGFR-2 alleles C of rs2071559, C of rs2305948 were significant predictors of PFS and OS. At multivariate analysis rs2010963, rs4604006 and BCLC (Barcelona Clinic Liver Cancer) stage resulted to be independent factors influencing PFS and OS. Once prospectively validated, the analysis of VEGF and VEGFR SNPs may represent a clinical tool to better identify HCC patients more likely to benefit from sorafenib. On the other hand, the availability of more accurate predictive factors could help avoiding unnecessary toxicities to potentially resistant patients who may be optimal candidates for different treatments interfering with other tumour molecular pathways., (© 2014 UICC.)

Published
2014
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4. Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound.

Author

Galassi M, Iavarone M, Rossi S, Bota S, Vavassori S, Rosa L, Leoni S, Venerandi L, Marinelli S, Sangiovanni A, Veronese L, Fraquelli M, Granito A, Golfieri R, Colombo M, Bolondi L, and Piscaglia F

Subjects
Aged, Bile Duct Neoplasms, Bile Ducts, Intrahepatic, Cholangiocarcinoma etiology, Diagnosis, Differential, Female, Humans, Italy, Liver Neoplasms etiology, Liver Neoplasms pathology, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Statistics, Nonparametric, Tomography, X-Ray Computed, Ultrasonography, Carcinoma, Hepatocellular diagnostic imaging, Cholangiocarcinoma diagnostic imaging, Cholangiocarcinoma pathology, Liver Cirrhosis complications, Liver Neoplasms diagnostic imaging
Abstract

Aim: Primary aim was to validate the percentage of intrahepatic cholangiocarcinomas (ICC) which have a contrast vascular pattern at contrast enhanced ultrasound (CEUS) at risk of misdiagnosis with hepatocellular carcinoma (HCC) and, secondary aim, to verify if any characteristics in the CEUS pattern helps to identify ICC., Methods: All ICC on cirrhosis seen in three Italian centres (Bologna, Milan and Pavia) between 2003 and 2011, in which CEUS and at least another imaging technique (CT or MRI) had been performed, were retrospectively identified. Those patients with ICC size comparable to the early HCC stage (Milan criteria, considered as small ICC) were enrolled for this study. The enhancement pattern at CEUS was analysed and compared with CT or MRI., Results: A total of 25 small ICC made this study group. CEUS was at risk of misdiagnosis of ICC for HCC in a significantly higher number of cases than in CT (performed in 24 ICC) (52% vs. 4.2%, P = 0.009) and MRI (11 ICC) (52% vs. 9.1%, P = 0.02). A different contrast pattern among all techniques was found in 6 of 10 ICC lesions submitted to the three imaging methods. In the arterial phase, ICC lacked global hyperenhacement in approximately 50% of cases at CEUS and the degree of intensity of wash-out in the late phase was marked in 24% of nodules., Conclusions: CEUS misdiagnosed as HCC a significantly higher number of ICC lesions in cirrhotic patients than CT and MRI. However, some CEUS contrast features can help suspect ICC, especially in some cases with inconclusive CT or MRI., (© 2013 John Wiley & Sons A/S.)

Published
2013
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5. Field-practice study of sorafenib therapy for hepatocellular carcinoma: a prospective multicenter study in Italy

Author

Iavarone, M, Piscaglia, F, Zavaglia, C, Grieco, A, Villa, E, Colombo, M, Sangiovanni, A, Vavassori, S, Romeo, R, Borghi, A, Granito, A, Bolondi, L, Airoldi, A, Pinzello, G, Biolato, M, Racco, S, Pompili, M, Lei, B, De Maria, N., CABIBBO, Giuseppe, CAMMA', Calogero, DI MARCO, Vito, CRAXI, Antonio, Iavarone, M, Cabibbo, G, Piscaglia, F, Zavaglia, C, Grieco, A, Villa, E, Cammà, C, Colombo, M, Sangiovanni, A, Vavassori, S, Romeo, R, Di Marco, V, Craxì, A, Borghi, A, Granito, A, Bolondi, L, Airoldi, A, Pinzello, G, Biolato, M, Racco, S, Pompili, M, Lei, B, De Maria, N, Iavarone M, Cabibbo G, Piscaglia F, Zavaglia C, Grieco A, Villa E, Cammà C, Colombo M, Sangiovanni A, Vavassori S, Romeo R, di Marco V, Craxì A, Borghi A, Granito A, Bolondi L, Airoldi A, Pinzello G, Bidato M, Racco S, Pompili M, Lei B, and De Maria N.

Subjects
Sorafenib, Niacinamide, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Drug-Related Side Effects and Adverse Reactions, Pyridines, Antineoplastic Agents, EPATOCARCINOMA, law.invention, Randomized controlled trial, law, Drug Toxicity, Internal medicine, medicine, Humans, Prospective Studies, HCC, Prospective cohort study, Survival analysis, Aged, sorafenib, Hepatology, business.industry, Phenylurea Compounds, Benzenesulfonates, Liver Neoplasms, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Hepatocellular, Middle Aged, medicine.disease, Survival Analysis, digestive system diseases, Surgery, Hepatocellular carcinoma, sorafenib, Regimen, TUMORI DEL FEGATO, Tolerability, Italy, Hepatocellular carcinoma, Disease Progression, Female, Liver cancer, business, medicine.drug
Abstract

A multicenter randomized controlled trial established sorafenib as a standard of care for patients with advanced hepatocellular carcinoma (HCC). Because the study was prematurely interrupted due to survival benefits in the sorafenib arm, we conducted an observational study to adequately assess risks and benefits of this regimen in field practice. Starting in 2008, all clinically compensated patients with advanced HCC and those with an intermediate HCC who were unfit or failed to respond to ablative therapies were consecutively evaluated in six liver centers in Italy, for tolerability as well as radiologic and survival response to 800-mg/d sorafenib therapy. Treatment was down-dosed or interrupted according to drug label. Two hundred ninety-six patients (88% Child-Pugh A, 75% Barcelona Clinic Liver Cancer [BCLC]-C, and 25% BCLC-B) received sorafenib for 3.8 months (95% CI 3.3-4.4). Two hundred sixty-nine (91%) patients experienced at least one adverse event (AE), whereas 161 (54%) had to reduce dosing. Treatment was interrupted in 103 (44%) for disease progression, in 95 (40%) for an AE, and in 38 (16%) for liver deterioration. The median survival was 10.5 months in the overall cohort, 8.4 months in BCLC-C versus 20.6 months in BCLC-B patients (P < 0.0001), and 21.6 months in the 77 patients treated for >70% of the time with a half dose versus 9.6 months in the 219 patients treated for >70% of the time with a full dose. At month 2 of treatment, the overall radiologic response was 8%. Eastern Cooperative Oncology Group performance status, macrovascular invasion, extrahepatic spread of the tumor, radiologic response at month 2, and sorafenib dosing were independent predictors of shortened survival. Conclusion: Overall, safety, effectiveness, and generalizability of sorafenib therapy in HCC was validated in field practice. The effectiveness of half-dosed sorafenib may have implications for tailored therapy.

Published
2011

6. Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma

Author

Matteo Angelo Manini, Angelo Sangiovanni, Fabio Fornari, Marco Biolato, Libera Fanigliulo, Elisa Ravaldi, Antonio Grieco, Massimo Colombo, Aghemo A, Grassi E, Iavarone M, Triolo M, Vavassori S, Giangregorio F, Pompili M, Gian Ludovico R, Riccardi L, De Gaetano AM, Forzenigo LV, Fraquelli M, Michieletti E., PISCAGLIA, FABIO, BOLONDI, LUIGI, GRANITO, ALESSANDRO, LEONI, SIMONA, MARINELLI, SARA, GOLFIERI, RITA, Matteo Angelo Manini, Angelo Sangiovanni, Fabio Fornari, Fabio Piscaglia, Marco Biolato, Libera Fanigliulo, Elisa Ravaldi, Antonio Grieco, Massimo Colombo, Aghemo A, Grassi E, Iavarone M, Triolo M, Vavassori S, Giangregorio F, Bolondi L, Granito A, Leoni S, Marinelli S, Pompili M, Gian Ludovico R, Riccardi L, De Gaetano AM, Forzenigo LV, Fraquelli M, Golfieri R, and Michieletti E.

Subjects
Adult, Liver Cirrhosis, Male, Clinical guidelines, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Biopsy, Fine-Needle, Contrast Media, Imaging techniques, Likelihood ratios in diagnostic testing, NaN, medicine, Humans, Prospective Studies, Diagnostic Errors, Societies, Medical, Aged, Ultrasonography, Aged, 80 and over, Surveillance, Cirrhosis, Clinical guidelines, Hepatocellular carcinoma, Imaging techniques, Surveillance, Hepatology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Ultrasound, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, United States, Liver biopsy, Practice Guidelines as Topic, Costs and Cost Analysis, Female, Radiology, Tomography, X-Ray Computed, Nuclear medicine, business, Algorithms, Contrast-enhanced ultrasound
Abstract

BACKGROUND AND AIMS: Although contrast-enhanced computed tomography (CT), dynamic magnetic resonance (MRI) and fine needle biopsy (FNB) are the standard of care to diagnose hepatocellular carcinoma (HCC), the clinical and economic benefits of the updated AASLD diagnostic algorithm, including the drop of contrast enhanced ultrasound (CEUS), have not been previously evaluated. METHODS: 119 de novo liver nodules detected during ultrasound (US) surveillance in 98 cirrhotics, 7 2cm in size, were sequentially examined by CEUS and CT, using MRI as a rescue approach in patients lacking a typical vascular pattern for HCC by one or both contrast techniques in the 1-2cm nodules and by CT in the >2cm nodules. A FNB was performed when required to meet both 2005 and 2010 AASLD criteria. RESULTS: Eighty-four (70%) nodules were HCC: the radiological diagnosis was done in 38 (88%) of those 1-2cm and in 38 (95%) for those >2cm HCCs according to 2010 AASLD criteria. CT or MRI detected 13 HCC nodules that were missed by unenhanced US. Despite an absolute specificity, CEUS failed to identify any HCC uncharacterized by CT or MRI. By updated AASLD criteria, 6 (17%) FNB procedures were spared in patients with 1-2cm nodules (p=0.025), as compared to 2005 criteria. The 2010 vs. 2005 AASLD per patient cost was similar in 1-2cm nodules, 432 € vs. 451 € (p=0.46), but lower in >2cm nodules, 248 € vs. 321 € (p

Published
2014

7. Imaging of combined hepatocellular-cholangiocarcinoma in cirrhosis and risk of false diagnosis of hepatocellular carcinoma

Author

Matteo Renzulli, Luigi Bolondi, Sara Vavassori, Horia Stefanescu, Marco Maggioni, Federico Stefanini, Francesco Tovoli, Fabio Piscaglia, Veronica Salvatore, Massimo Colombo, Massimo Iavarone, E. Sagrini, Sagrini E., Iavarone M., Stefanini F., Tovoli F., Vavassori S., Maggioni M., Renzulli M., Salvatore V., Stefanescu H., Colombo M., Bolondi L., and Piscaglia F.

Subjects
Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Liver tumor, primary liver cancer, Enhancement pattern, Malignancy, Multimodal Imaging, liver imaging, Cholangiocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, Diagnostic Errors, Aged, Ultrasonography, medicine.diagnostic_test, business.industry, Liver Neoplasms, Ultrasound, Gastroenterology, Magnetic resonance imaging, Original Articles, Middle Aged, Image Enhancement, medicine.disease, Magnetic Resonance Imaging, digestive system diseases, Tumor Burden, Bile Duct Neoplasms, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, CEUS, Female, 030211 gastroenterology & hepatology, Radiology, Tomography, X-Ray Computed, business, Biomarkers, contrast-enhanced ultrasound, Contrast-enhanced ultrasound
Abstract

Background: Diagnosis of hepatocellular carcinoma can be achieved by imaging in cirrhotic patients. Combined hepatocellular-cholangiocarcinoma is a primary liver tumor and its imaging patterns have been poorly investigated. Misdiagnosis for either hepatocellular carcinoma or benign lesions can occur. We aimed to evaluate the enhancement pattern of combined hepatocellular-cholangiocarcinoma in cirrhosis with imaging techniques and to estimate the risk of misdiagnosis for hepatocellular carcinoma. Methods: All histology-confirmed combined hepatocellular-cholangiocarcinoma in cirrhosis seen in two Italian centers between 2003 and 2016, in which at least one imaging technique had been performed, was retrospectively collected. The enhancement pattern was analyzed for all available imaging modalities. Results: A total of 37 combined hepatocellular-cholangiocarcinoma nodules were identified. Contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging had been performed in 27, 34, and 17 nodules, respectively. Contrast-enhanced ultrasound was at higher risk of misdiagnosis for pure hepatocellular carcinoma than computed tomography (p = 0.005) or magnetic resonance imaging (p = 0.040). Only six of 24 combined hepatocellular-cholangiocarcinoma lesions submitted to both contrast-enhanced ultrasound and computed tomography showed coincident patterns; contrast-enhanced ultrasound correctly suggested a condition of malignancy in a higher number of cases than computed tomography (p < 0.001) and magnetic resonance imaging (p = 0.002). Conclusions: Contrast-enhanced ultrasound misdiagnosed a higher number of combined hepatocellular-cholangiocarcinoma as hepatocellular carcinoma than computed tomography and magnetic resonance imaging. However, the latter techniques were able to identify features of malignancy less often.

Published
2019

8. Predictors of survival in patients with advanced hepatocellular carcinoma who permanently discontinued sorafenib

Author

Massimo Colombo, C. Cammà, Michele Basso, Marco Barbara, Antonio Craxì, Sara Vavassori, Cristina Della Corte, Marcello Maida, Antonio Grieco, Giuseppe Cabibbo, Massimo Iavarone, Marco Biolato, Iavarone M., Cabibbo G., Biolato M., Della Corte C., Maida M., Barbara M., Basso M., Vavassori S., Craxi A., Grieco A., Camma C., and Colombo M.

Subjects
Male, Predictive Value of Test, Gastroenterology, Cohort Studies, Antineoplastic Agent, Prospective Studies, Prospective cohort study, Multivariate Analysi, Liver Neoplasms, Hepatitis C, Middle Aged, Sorafenib, Italy, Liver Neoplasm, Hepatocellular carcinoma, Female, Survival Analysi, medicine.drug, Human, Niacinamide, Phenylurea Compound, medicine.medical_specialty, Carcinoma, Hepatocellular, Drug-Related Side Effects and Adverse Reactions, Settore MED/12 - GASTROENTEROLOGIA, Reproducibility of Result, Antineoplastic Agents, Risk Assessment, Predictive Value of Tests, Internal medicine, medicine, Humans, Neoplasm Invasiveness, Survival analysis, Aged, Neoplasm Staging, Neoplasm Invasivene, Analysis of Variance, Hepatology, Performance status, business.industry, Phenylurea Compounds, Patient Selection, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Reproducibility of Results, Hepatocellular, medicine.disease, Survival Analysis, Surgery, Discontinuation, Prospective Studie, Withholding Treatment, Multivariate Analysis, Cohort Studie, business, Drug-Related Side Effects and Adverse Reaction
Abstract

Treatment with sorafenib of patients with advanced hepatocellular carcinoma is challenged by anticipated discontinuation due to tumor progression, liver decompensation, or adverse effects. While postprogression survival is clearly determined by the pattern of tumor progression, understanding the factors that drive prognosis in patients who discontinued sorafenib for any reason may help to improve patient management and second-line trial design. Patients consecutively admitted to three referral centers who were receiving best supportive care following permanent discontinuation of sorafenib for any reason were included. Postsorafenib survival (PSS) was calculated from the last day of treatment to death or last visit available. Two hundred and sixty patients were included in this prospective study, aged 67 years, 60% with hepatitis C, 51% Child-Pugh A, 83% performance status (PS) ≥1, 41% with macroscopic vascular invasion, and 38% with extrahepatic tumor spread. Overall, median PSS was 4.1 (3.3-4.9) months, resulting from 4.6 (3.3-5.7) months for 123 progressors, 7.3 (6.0-10.0) months in 77 with adverse effects, and 1.8 (1.6-2.4) months in 60 decompensated patients (P

Published
2015

9. Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound

Author

Simona Leoni, Simona Bota, Fabio Piscaglia, Massimo Iavarone, Mirella Fraquelli, Alessandro Granito, Angelo Sangiovanni, Massimo Colombo, Rita Golfieri, L. Venerandi, Sara Marinelli, Laura Conde de la Rosa, Sara Vavassori, M. Galassi, Letizia Veronese, Sandro Rossi, Luigi Bolondi, Galassi M, Iavarone M, Rossi S, Bota S, Vavassori S, Rosa L, Leoni S, Venerandi L, Marinelli S, Sangiovanni A, Veronese L, Fraquelli M, Granito A, Golfieri R, Colombo M, Bolondi L, and Piscaglia F

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Carcinoma, Hepatocellular, Milan criteria, Statistics, Nonparametric, Cholangiocarcinoma, Diagnosis, Differential, Medicine, Humans, Intrahepatic Cholangiocarcinomas, Stage (cooking), CIRRHOSIS, Intrahepatic Cholangiocarcinoma, Aged, Retrospective Studies, Ultrasonography, CONTRAST ENHANCED ULTRASONOGRAPHY, Hepatology, business.industry, Liver Neoplasms, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Bile Ducts, Intrahepatic, Bile Duct Neoplasms, Italy, Hepatocellular carcinoma, Female, Radiology, business, Tomography, X-Ray Computed, Contrast-enhanced ultrasound, Arterial phase
Abstract

AIM: Primary aim was to validate the percentage of intrahepatic cholangiocarcinomas (ICC) which have a contrast vascular pattern at contrast enhanced ultrasound (CEUS) at risk of misdiagnosis with hepatocellular carcinoma (HCC) and, secondary aim, to verify if any characteristics in the CEUS pattern helps to identify ICC. METHODS: All ICC on cirrhosis seen in three Italian centres (Bologna, Milan and Pavia) between 2003 and 2011, in which CEUS and at least another imaging technique (CT or MRI) had been performed, were retrospectively identified. Those patients with ICC size comparable to the early HCC stage (Milan criteria, considered as small ICC) were enrolled for this study. The enhancement pattern at CEUS was analysed and compared with CT or MRI. RESULTS: A total of 25 small ICC made this study group. CEUS was at risk of misdiagnosis of ICC for HCC in a significantly higher number of cases than in CT (performed in 24 ICC) (52% vs. 4.2%, P = 0.009) and MRI (11 ICC) (52% vs. 9.1%, P = 0.02). A different contrast pattern among all techniques was found in 6 of 10 ICC lesions submitted to the three imaging methods. In the arterial phase, ICC lacked global hyperenhacement in approximately 50% of cases at CEUS and the degree of intensity of wash-out in the late phase was marked in 24% of nodules. CONCLUSIONS: CEUS misdiagnosed as HCC a significantly higher number of ICC lesions in cirrhotic patients than CT and MRI. However, some CEUS contrast features can help suspect ICC, especially in some cases with inconclusive CT or MRI.

Published
2012

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