In contrast, this imaging method has been reported to be useful for assessing the therapeutic effect and identifying distant metastasis. While adequate objective comparison with other tests has not yet been made, FDG-PET is expected to play an important role in the clinical setting in the future (LF006735 level 1, LF107656 level 2b). Liver scintigraphy is not indicated

as an imaging method for the diagnosis of hepatocellular carcinoma because of its low detection capability on account of the limited spatial resolution. FDG-PET is based on the principle that this substance is taken up by tumor cells that show active glucose metabolism and Fulvestrant mw specifically accumulates in these cells by blocking the metabolic pathway. In metastatic liver cancer, with a decrease in the accumulation of FDG in the surrounding normal tissues, good FDG-PET images with a higher tumor/normal ratio can be obtained. However, for hepatocellular carcinomas showing a high degree of differentiation, FDG is dephosphorylated

again after phosphorylation and spreads out of the cells without showing sufficient accumulation. Therefore, FDG-PET is not recommended for the detection of primary hepatocellular carcinomas, because it is expensive, is not listed in the national health-care FK506 supplier system and is not superior to conventional diagnostic imaging modalities such as CT and/or MRI. In contrast, it is expected to be useful for the diagnosis of extrahepatic metastases and for assessment of the effect of therapy; thus, FDG-PET may have a role during systemic chemotherapy for hepatocellular carcinoma. CQ13 Is histologic diagnosis by needle biopsy necessary for a definitive diagnosis of hepatocellular carcinoma? Histologic diagnosis is not necessary when the diagnosis of hepatocellular carcinoma is determined by diagnostic imaging. (grade D) Histologic diagnosis by biopsy is indicated when imaging findings are atypical.

In such cases, the indications should be carefully determined according to individual patients. (grade C1) The diagnostic sensitivity of ultrasound-guided needle biopsy for hepatocellular carcinoma is 88.1–90% (LF104651 level 1, LF000872 level 1), the PPV is 100%, Methamphetamine negative predictive value (NPV) is 13–51.7% and the accuracy is 89.4–91% (LF104651 level 1, LF000872 level 1). False negatives are noted in 10–10.6% (LF000872 level 1, LF104651 level 1). The diagnostic sensitivity of fine needle biopsy for tumors 10 mm or less in diameter is 72.7% (24/33 nodules) (LF104651 level 1). Of 160 patients (225 benign or malignant lesions) who underwent resection determined by integrated diagnostic imaging without preoperative needle biopsy, the diagnosis made by preoperative diagnostic imaging was reported as correct in 156 patients (97.5%) (221 lesions, 98.2%) (LF022163 level 1). Serious complications associated with needle biopsy include needle tract seeding and hemorrhage. The incidence of the former is reported to be 1.6–3.