Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients.

The purpose of this study was to assess the usefulness of ultrasonography in the detection of hepatocellular carcinomas and dysplastic nodules in patients with liver cirrhosis. Pretransplantation sonograms in 52 patients with liver cirrhosis who underwent orthotopic liver transplantation were evaluated retrospectively. The numbers of hepatocellular carcinomas and dysplastic nodules were assessed in the explanted liver specimens and compared with pretransplantation ultrasonographic results. Eighteen hepatocellular carcinomas in 16 patients and 20 dysplastic nodules in 11 patients were present in the explanted livers. The size of hepatocellular carcinomas ranged from 0.6 to 5.0 cm (mean, 2.1 cm) in diameter, and that of dysplastic nodules ranged from 0.5 to 1.7 cm (mean, 1.0 cm) in diameter. Pretransplantation ultrasonography enabled detection of 6 of 18 hepatocellular carcinoma and 0 of 20 dysplastic nodule lesions; lesion detection sensitivity for hepatocellular carcinomas and dysplastic nodules was 33% and 0%, respectively. Patient sensitivity and specificity for hepatocellular carcinomas were 38% (6 of 16) and 92% (33 of 36), and those for dysplastic nodules were 0% and 95% (39 of 41), respectively. On the basis of our results, ultrasonography is insensitive for detection of hepatocellular carcinomas and dysplastic nodules in patients with advanced liver cirrhosis.