Hepatocellular carcinomas within the Milan criteria: Predictors of histologic necrosis after drug-eluting beads transarterial chemoembolization

Bruno C. Odisio, Francisco Galastri, Rony Avritscher, Breno B. Afonso, Vanderlei Segatelli, Guilherme E.G. Felga, Paolo R.O. Salvalaggio, Joe Ensor, Michael J. Wallace, Felipe Nasser

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Purpose: To evaluate pathologic, imaging, and technical predictors of therapy response in patients with hepatocellular carcinoma (HCC) within the Milan criteria undergoing doxorubicin drug-eluting beads transarterial chemoembolization (DEB-TACE) before orthotopic liver transplantation (OLT). Methods: This prospective study included consecutive patients with HCC who underwent DEB-TACE before OLT. Tumor histologic necrosis on liver explants was utilized as the standard of reference to categorize treated HCCs as group 1 (>50 % necrosis) or group 2 (≤50 % necrosis). DEB-TACE technique, histological factors, and imaging evaluation utilizing the modified Response Evaluation Criteria in Solid Tumors (mRECIST) were compared between groups 1 and 2. Results: Twenty-seven HCCs were identified in 23 patients. Group 1 comprised 18 HCCs (mean necrosis 86.2 %). Group 2 comprised 9 HCCs (mean necrosis 31.1 %). The mean time between the last DEB-TACE session and the OLT was 112 days. Lesion size was significantly larger in group 1 (mean 3.2 cm; 95 % confidence interval 2.55-3.85) than in group 2 (mean 2.1 cm; 95 % confidence interval 1.79-2.48) (p = 0.030). Group 1 also demonstrated a higher frequency of encapsulated lesions when compared to group 2 (78 % vs. 22 %; p = 0.0027). A significant linear correlation was found between the quantification of necrosis by imaging and pathology (p = 0.0011) using the mRECIST, with a poorer correlation index in group 2. Conclusion: Larger and encapsulated HCCS are associated with a higher percentage of necrosis. A significant linear correlation between the amount of necrosis by imaging and pathology was encountered when mRECIST was utilized.

Original languageEnglish (US)
Pages (from-to)1018-1026
Number of pages9
JournalCardioVascular and Interventional Radiology
Issue number4
StatePublished - Aug 2014


  • Drug-eluting beads
  • Hepatocellular carcinoma (HCC)
  • Interventional oncology
  • Modified RECIST
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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