Clinicopathological assessment of steatohepatitic hepatocellular carcinoma

Abstract

Aim: To compare the clinicopathological features of typical steatohepatitic HCC (SH-HCC) with other HCCs.

Methods: Subjects were 486 patients with untreated HCC who underwent hepatectomy at our hospital from January 2015 to December 2020. We compared patient backgrounds, preoperative laboratory data, imaging findings (ultrasonography, computed tomography [CT], and magnetic resonance imaging [MRI]), and postoperative pathological findings (tumor and background of liver). The Liver Imaging Reporting And Data System (LI-RADS) was used to examine CT and MRI findings.

Results: Typical SH-HCCs were significantly different from other HCCs with respect to age, hepatitis B virus (HBV) infection, and nonalcoholic steatohepatitis (NASH). Diabetes and hyperlipidemia were also significantly more common. Regarding histopathology, tumor size and background steatosis were significantly different between groups. Although ultrasonography, CT, and MRI could each alone diagnose SH-HCCs with a diameter < 20 mm in ≥ 50% of patients, the combined use of these tests improved diagnostic accuracy. By LI-RADS, 87% of SH-HCC cases were classified as LR-5, which are considered to be malignant tumors.

Conclusions: It seems possible to diagnose SH-HCC by combining ultrasonography, CT, and MRI.

Keywords: Computed tomography; Liver imaging reporting and data system 2018; Magnetic resonance imaging; Steatohepatitic hepatocellular carcinoma; Ultrasonography; WHO classification.