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Early Hepatocellular Carcinoma: Pathology, Imaging, and Therapy

¹ Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
² Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
³ Department of Pathology, Kurume University School of Medicine, Kurume, Japan
⁴ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
⁵ Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
⁶ Department of Medical Imaging, University of Toronto, Toronto, Canada
⁷ Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
⁸ Department of Radiology, New York University, New York, New York, USA

Correspondence: Address correspondence and reprint requests to: Tadatoshi Takayama, MD; E-mail: tadtak{at}med.nihon-u.ac.jp

Background: In 1987, Japanese researchers proposed to define the pathological concept of early hepatocellular carcinoma (HCC). However, there are some conceptual differences between the East and the West in the diagnosis and treatment of early HCC.

Methods: To provide up-to-date data for making a worldwide consensus, this article has collected six papers focused on the management of early HCC, which were presented in the Fifth International Meeting of "Hepatocellular Carcinoma: Eastern and Western Experiences" in Houston in January 2007.

Results: In the pathological perspective, the common criteria to discriminate early HCC from dysplastic nodule included hepatocytic invasion of portal triads and septa (stromal invasion). The current imaging modalities such as contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) with the use of intravenous contrast material with multiphasic imaging could enhance their ability to accurately characterize early HCC. From the treatment perspective, a single early HCC had a high chance for cure by resection, ablation, or transplantation, which proved to be the earliest clinical entity (Stage 0 HCC).

Conclusions: Early HCC is characterized by its incipient malignant nature and by an extremely favorable clinical outcome, thereby justifying its definition.

Key Words: Hepatocellular carcinoma • Early HCC • Pathology • Imaging • Therapy