Prevalence and Diagnosis of Incidental Hepatocellular Carcinoma in Surgical Patients Submitted to Liver Transplantation at Santa Isabel Hospital in Blumenau (SC)

Abstract

Objectives: To quantify the frequency of incidental hepatocellular carcinoma (iHCC) and evaluate the reasons for liver transplantation in the study population and the accuracy of imaging tests in diagnosing hepatocellular carcinoma (HCC) in a liver transplant referral center. Methods: Retrospective sectional study conducted based on 426  medical records of patients who underwent liver transplantation at the Hospital Santa Isabel in Blumenau (SC), between January 2016 and December 2019. The pathology reports of the explanted livers, the evolution of the patients, and the reports of the imaging exams performed up to six months before the transplant were evaluated. Patients under 18 years of age, history of retransplantation, fulminant liver failure, metabolic liver disease, autoimmune hepatitis, and other etiologies of liver failure with a lower risk of developing HCC were excluded. Results: Of the 426 transplant patients, 89 were excluded. Among those included, 190 (56.38%) were transplanted for cirrhosis without previously diagnosed HCC and 147 (43.62%) for previously diagnosed HCC. The frequency of iHCC was 7.89% (15/190). Hepatitis C virus was more frequent among patients with previously diagnosed HCC than among those with iHCC (p = 0.033). Magnetic resonance imaging (MRI) was the most sensitive and least specific test (S = 100%; E = 75.76%). Computed tomography (CT) showed high sensitivity and specificity (S = 93.75%; E = 90%), while ultrasonography showed low sensitivity and high specificity (S = 56.76%; E = 97.86%). Conclusion: This study found similar data to the international literature regarding the frequency of iHCC. Ultrasonography was the least sensitive test, while CT and MRI showed higher sensitivity than seen in the literature. The MRI showed lower specificity than most of the references analyzed.