Joseph Ralph Kallini1, Ahmed Gabr1, Ryan Hickey1, Laura Kulik2, Kush Desai1, Yihe Yang1, Vanessa L Gates1, Ahsun Riaz1, Riad Salem1,3, Robert J Lewandowski4. 1. Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair Street, Suite 800, Chicago, IL, USA. 2. Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, 60611, USA. 3. Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. 4. Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair Street, Suite 800, Chicago, IL, USA. r-lewandowski@northwestern.edu.
Abstract
PURPOSE: To determine the correlation of pre-procedural and imaging characteristics with lung shunt fraction (LSF) measured by technetium-99 m macroaggregated albumin (99mTc-MAA) scan in patients with hepatocellular carcinoma. METHODS: A retrospective study was conducted of 428 subjects with hepatocellular carcinoma from 2004 to 2011 assessed for lung shunting by 99mTc-MAA scan. Baseline characteristics included age, gender, ethnicity, tumor burden, maximum dimension, number of lesions, presence of extrahepatic metastases, macrovascular (hepatic and portal vein) invasion, ascites on imaging, laboratory values, and alpha-fetoprotein (AFP). Univariate and multivariate logistic regression analysis was performed. Receiver operating characteristic curves were used to obtain sensitivity (SN), specificity (SP), and positive likelihood ratios (LR+) of characteristics for low LSF (LSF <10%) and high LSF (LSF >20%). RESULTS: Statistically significant (p < 0.05) independent indicators of low LSF included bilirubin <1.45 mg/dL (SN = 49.5%, SP = 69.1%, LR+ = 1.60), maximum tumor size <7.15 cm (SN = 66.0%, SP = 75.9%, LR+ = 2.74), AFP ≤200 ng/mL (SN = 64.6%, SP = 65.0%, LR+ = 1.85), and absent macrovascular invasion (SN = 73.9%, SP = 64.9%, LR+ = 2.11). Independent indicators of high LSF included albumin <2.65 g/dL (SN = 64.3%, SP = 64.1%, LR+ = 1.79) and macrovascular invasion (SN = 74.4%, SP = 67.4%, LR+ = 2.28). A combined risk factor model was constructed. If there is no macrovascular invasion: [Formula: see text]. With macrovascular invasion, [Formula: see text] (R 2 = 0.257). Since these factors all have LR+ between 2 and 5, they only reflect slight increase in LSF predictivity. CONCLUSION: Serum AFP, albumin, bilirubin, and portal/hepatic vein invasion on cross-sectional imaging are statistically significant but weak clinical indicators of LSF, as shown by low SN, SP, and LR+ for clinically relevant cutoff LSF values. Thus, these factors cannot be relied upon in clinical practice.
PURPOSE: To determine the correlation of pre-procedural and imaging characteristics with lung shunt fraction (LSF) measured by technetium-99 m macroaggregated albumin (99mTc-MAA) scan in patients with hepatocellular carcinoma. METHODS: A retrospective study was conducted of 428 subjects with hepatocellular carcinoma from 2004 to 2011 assessed for lung shunting by 99mTc-MAA scan. Baseline characteristics included age, gender, ethnicity, tumor burden, maximum dimension, number of lesions, presence of extrahepatic metastases, macrovascular (hepatic and portal vein) invasion, ascites on imaging, laboratory values, and alpha-fetoprotein (AFP). Univariate and multivariate logistic regression analysis was performed. Receiver operating characteristic curves were used to obtain sensitivity (SN), specificity (SP), and positive likelihood ratios (LR+) of characteristics for low LSF (LSF <10%) and high LSF (LSF >20%). RESULTS: Statistically significant (p < 0.05) independent indicators of low LSF included bilirubin <1.45 mg/dL (SN = 49.5%, SP = 69.1%, LR+ = 1.60), maximum tumor size <7.15 cm (SN = 66.0%, SP = 75.9%, LR+ = 2.74), AFP ≤200 ng/mL (SN = 64.6%, SP = 65.0%, LR+ = 1.85), and absent macrovascular invasion (SN = 73.9%, SP = 64.9%, LR+ = 2.11). Independent indicators of high LSF included albumin <2.65 g/dL (SN = 64.3%, SP = 64.1%, LR+ = 1.79) and macrovascular invasion (SN = 74.4%, SP = 67.4%, LR+ = 2.28). A combined risk factor model was constructed. If there is no macrovascular invasion: [Formula: see text]. With macrovascular invasion, [Formula: see text] (R 2 = 0.257). Since these factors all have LR+ between 2 and 5, they only reflect slight increase in LSF predictivity. CONCLUSION: Serum AFP, albumin, bilirubin, and portal/hepatic vein invasion on cross-sectional imaging are statistically significant but weak clinical indicators of LSF, as shown by low SN, SP, and LR+ for clinically relevant cutoff LSF values. Thus, these factors cannot be relied upon in clinical practice.
Entities:
Keywords:
Hepatocellular carcinoma (HCC); Hepatopulmonary shunt; Lung shunt fraction (LSF); Radioembolization; Risk factors; Technetium-99 m macroaggregated albumin (99mTc-MAA); Yttrium-90
Authors: Alexander Villalobos; Mohamed M Soliman; Bill S Majdalany; David M Schuster; James Galt; Zachary L Bercu; Nima Kokabi Journal: Semin Intervent Radiol Date: 2020-12-11 Impact factor: 1.513
Authors: Michael Köhler; Moritz Wildgruber; Max Masthoff; Philipp Schindler; Fabian Harders; Walter Heindel; Christian Wilms; Hartmut H Schmidt; Andreas Pascher; Lars Stegger; Kambiz Rahbar Journal: J Cancer Res Clin Oncol Date: 2020-11-06 Impact factor: 4.553