Adult cirrhotic liver explants: Precancerous lesions and undetected small hepatocellular carcinomas

Background & Aims: Despite recent advances in imaging techniques of the liver, it remains difficult to detect small precancerous lesions or hepatocellular carcinomas (HCCs) in cirrhotic livers. The goal of this study was to determine the prevalence of undetected small HCCs in liver explants of adult cirrhotic patients undergoing liver transplantation and to evaluate the association of HCCs with hepatic lesions considered premalignant. Methods: Eighty consecutive liver explants were analyzed for the presence of macroscopically atypical nodules, which were then pathologically described as macroregenerative nodules, high-grade dysplastic nodules, areas of small liver cell dysplasia, and HCCs. Results: The prevalence of HCC was 17.5% with a mean size of 11.6 mm. HCCs were more frequently found in men (22%) than in women (4.8%; P < 0.05) and in patients older than 50 years at the time of liver transplantation (35.7% vs. 7.7% in patients younger than 50 years; P < 0.05). The prevalence of HCCs was identical in alcoholic and viral cirrhosis, HCC nodules were significantly associated with the presence of high-grade dysplastic nodules. Conclusions: Small HCCs and precancerous lesions are frequently found in cirrhotic liver explants, especially in men older than 50 years. This finding should be included in the decisionmaking analysis for liver transplantation.