ABSTRACT
BACKGROUND: Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. METHODS: This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. RESULTS: Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. CONCLUSION: The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy.
Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Biopsy/statistics & numerical data , Carcinoma, Hepatocellular/drug therapy , Cholangiocarcinoma , Humans , Liver Neoplasms/drug therapy , Magnetic Resonance Imaging/statistics & numerical data , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Tomography, X-Ray Computed/statistics & numerical data , United Kingdom , Young AdultABSTRACT
Prostate artery embolization (PAE) is a minimally invasive technique in managing men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is one of the commonest causes of LUTS in men, associated with high morbidity and economic burden. Patients suffering from LUTS secondary to BPH, severe enough to warrant intervention traditionally underwent transurethral resection of the prostate or open prostatectomy. PAE is an emerging alterative technique with promising data. In this paper we review important elements to running a safe PAE practice including careful patient selection, exclusion criteria, complications, and efficacy of PAE compared to other techniques. This paper also reviews the basic anatomy and techniques relevant to PAE, including common anatomical variants.