"Complete or near complete necrosis was achieved in 61% of patients who underwent [chemoembolization]," said Stacy Urgas, medical student, Columbia University, New York, New York, United States, working with colleagues led by Nishita Kothary, MD, assistant professor of radiology, Columbia University.

Ms. Urgas said that 41 patients had undergone transarterial chemoembolization prior to transplant. The average time from chemoembolization to transplantation was 104 days, but that ranged greatly from 0 days to 641 days. The median time was 66 days.

In evaluating the ex-planted liver specimens, pathologists determined that there was complete necrosis of the tumor in 14 patients, with no evidence of any viable malignant cells. Another 11 patients had predominantly necrosed tumors, but minimal or microscopic evidence of residual malignant cells could be located in the tissue.

In the remaining 16 patients, pathologists were able to observe predominantly viable tumors with macroscopic evidence of residual disease.

Ms. Urgas noted that many liver tumors can be supported by both arterial and venous blood supplies, so blocking the arterial route may not suffice in choking off blood supply to the tumor, thereby allowing tumors to remain viable.

In the same oral session, Dr. Kothary presented a separate report in which a different examination of 22 other explanted livers turned up a surprising and disturbing fact: "We missed about half these tumors [using computer-assisted tomography techniques]," Dr. Kothary stated, noting that 12 of 22 tumors were not reported previous to transplantation. In 11 cases, magnetic resonance imaging was used to locate tumors in livers of soon-to-be transplanted individuals. "In those patients, we missed 5 tumors," she said.

"Imaging is our Holy Grail," Dr. Kothary commented, adding that doctors must realize shortcomings in even the best imaging devices when seeking to locate all malignancies in liver-cancer patients.


[Presentation title: Histopathologic Correlation after Chemoembolization in Patients Undergoing Liver Transplantation. Abstract 18]

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