Moucari R et al. - In a trial to analyze characteristics of and the factors associated with development of hepatocellular carcinoma (HCC) in pts with Budd-Chiari syndrome (BCS), it was found that the incidence of HCC was similar to that reported for other chronic liver diseases. IVC obstruction was a major predictor for HCC development. Serum AFP appears to have a higher utility for HCC screening in pts with BCS than with other liver diseases Methods
97 consecutive pts with BCS and a follow-up >=1 year were retrospectively evaluated
Liver nodules were evaluated using serum α-fetoprotein (AFP) level and imaging features (CT/MRI)
Biopsy of nodules was obtained when one of the following criteria was met: number <=3, diameter >=3 cm, heterogeneity, washout on portal venous phase, increase in size on surveillance, or increase in AFP level
Results
Pts were mainly Caucasian and female
Mean age at the diagnosis of BCS was 35.8, and median follow-up 5 years
Inferior vena cava (IVC) was obstructed in 13 pts; liver nodules were found in 43 pts, 11 of whom had HCC
Cumulative incidence of HCC during follow-up was 4%
Liver parenchyma adjacent to HCC showed cirrhosis in 9 pts
HCC was associated with: male sex, factor V Leiden, and IVC obstruction
Increased serum AFP level had a high accuracy to distinguish HCC from benign nodules: PPV=100% and NPV=91% for a cut-off level of 15ng/ml
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