0 statistical package (Stata 1944-2007, College Station, TX). Sixty-two HCC nodules were detected consecutively in 59 patients with cirrhosis who were under surveillance

with US (Table 2). The diagnosis of HCC was histologically confirmed in liver biopsy cores ranging from 0.9 to 5.0 cm (median 1.6 cm). To assess intra-assay variation, 18 tumors (29%) were sampled twice during the same session, and the cores were blindly assessed for tumor cell differentiation by the same pathologist. Thirteen (72%) tumors yielded concordant readings (mean size 1.8 cm, weighted K 0.615), whereas in the five nodules with discordant results (mean size 1.8 cm), the worst grading was considered. Only one of the five discordant HCCs was a grade I versus grade PXD101 in vitro II tumor, whereas the remaining four nodules were discordant for grade II versus grade III. There were 18 (29%) grade I tumors with a median size of 1.5 cm (range 1.1-2.5 cm), 28 (45%) grade II tumors with a median size of 1.5 (range 1.0-3.0 cm), 16 (26%) grade III tumors with a Selleck BGJ398 median size of 1.8 (range 1.0-2.6 cm), and no grade

IV tumors. Of the 47 tumors measuring 1-2 cm in size, 16 (34%) were grade I, 20 (43%) were grade II, and 11 (23%) were grade III. Table 3 shows the correlation between the results of contrast imaging techniques and tumor cell grading. CE-US yielded a combined pattern of contrast wash-in and wash-out in three (17%) grade I and 18 (41%) grade II-III tumors (P = 0.08). CT yielded the typical vascular pattern in three (17%) grade I and 29 (66%) grade II-III nodules (P = 0.0006). Finally, MRI gave the typical vascular pattern in four (25%) grade I and 25 (57%) grade II-III nodules (P = 0.01). The distribution of tumor cell grading was similar according to patient age, disease etiology, serum levels of liver enzymes, tumor size, and serum AFP values (Table 3). Table 4 shows the correlation

between the results of contrast imaging techniques and tumor size. Of the 1- to 2-cm nodules showing two coincidental results by contrast imaging techniques, a radiological diagnosis was obtained in two of 12 (17%) grade I tumors and 17 of 31 (55%) grade II-III tumors (P = 0.006) (Table 5). Selleck Erlotinib Multivariate analysis revealed that tumor cell dedifferentiation (odds ratio 12.38; 95% confidence interval 2.39-64.13; P = 0.003) and tumor size (odds ratio 3.73; 95% confidence interval 1.15-12.13; P = 0.029) were found to directly correlate with an increased likelihood of a radiological diagnosis of HCC (Table 6). Tumor grade has clinical implications in HCC, because it correlates with well-established predictors of disease severity and recurrence after surgery, such as number and size of tumor nodules and portal invasion by tumor cells.14-18 The present study is the first to evaluate cell grading in small HCC nodules detected during surveillance of patients with cirrhosis, thus adding to the data regarding cell grading in both small and large HCC nodules in surgically resected livers.