Limitation of Modified RECIST - Two Hepatocellular Carcinoma Cases Achieving Radiological Response Incompatible with Histopathological Analysis

Soo Ki Kim, Takako Fujii, Hisato Kobayashi, Soo Ryang Kim, Yu-ichiro Koma, Tsutomu Kumabe, Osamu Nakashima and Takamichi Murakami

Department of Gastroenterology, Kobe Asahi Hospital, Japan
Department of Radiology, Kobe Asahi Hospital, Japan
Department of Pathology, Kobe University Graduate School of Medicine, Japan
Kumabe Clinic, Japan
Department of Clinical Laboratory Medicine, Kurume University Hospital, Japan
Department of Radiology, Kobe University Graduate School of Medicine, Japan

^*Correspondance to: Takako Fujii 

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Abstract:

We encountered two cases of Hepatocellular Carcinoma (HCC) treated with molecular-targeted therapy such as Lenvatinib (LEN), assessed as complete responders through radiological evaluation with Contrast Enhanced Computer Tomography (CECT) and gadolinium Contrast Enhanced Magnetic Resonance Imaging (CEMRI) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Nonetheless, the response was incompatible with histopathological analysis.
In both cases, more than 6 weeks of post-LEN treatment, CECT and CEMRI revealed complete absence of intratumoral arterial contrast enhancement; however, ultrasound guided biopsy revealed moderately differentiated HCC with or without coagulation necrosis.
Subsequent to the total absence of intratumoral arterial contrast enhancement, MRI revealed hyper intensity on Diffusion-Weighted Imaging (DWI) and hypointensity on the Apparent Diffusion Coefficient (ADC) -map.
mRECIST depends on only complete absence of intratumoral arterial enhancement, and has limitations in tumor response assessment of post-molecular-targeted therapy.
MRI on DWI and ADC-map may be useful and more effective when complemented with mRECIST in order to improve the diagnostic accuracy and viability of HCC.

Keywords:

Modified RECIST; Complete response; Coagulation necrosis; Molecular-targeted therapy; Diffusion-weighted imaging

Cite the Article:

Kim SK, Fujii T, Kobayashi H, Kim SR, Koma Y-I, Kumabe T, et al. Limitation of Modified RECIST - Two Hepatocellular Carcinoma Cases Achieving Radiological Response Incompatible with Histopathological Analysis. Clin Oncol. 2021;6:1848..