Here is an example of the results of anslysis of individual nodules:
The number of dysplastic nodules detected clinically has increased since patients with hepatitis virus-associated cirrhosis, who are at increased risk for hepatocellular carcinoma (HCC), began to undergo regular cancer surveillance. Although it is potentially important to determine which type(s) of nodule may be prone to progress to HCC, outcomes of dysplastic nodules have not been fully investigated. This prompted us to examine the outcomes of dysplastic nodules in cirrhotic patients clinicopathologically. We studied 33 dysplastic nodules of <20 mm in maximum diameter, diagnosed by fine needle aspiration biopsy under ultrasonography (US). These nodules were clinically followed, mainly by US examination, for up to 70 months. When the nodules enlarged or exhibited changes on US, they were histologically reexamined by second biopsy. Surprisingly, 15 of the 33 nodules (45.5%) disappeared, 14 nodules (42.4%) remained unchanged, and only 4 nodules (12.1%) progressed to HCC. The latter 4 nodules were all hyperechoic on US and were composed of clear cells with fatty change or small cells with increased nuclear density, and in all 4 patients serum was positive for hepatitis C virus antibody. Univariate analyses revealed that, although not significant, the hyperechoic nodules or nodules with small cell change showed a higher HCC progression rate in comparison with the hypoechoic nodules or the nodules without small cell change. In summary, most of the dysplastic nodules we followed disappeared or remained unchanged, but some progressed to HCC. Hyperechoic nodules in patients with hepatitis C virus-associated cirrhosis, which show small cell change with increased nuclear density, may be prone to progress to HCC.
Nodules are mostly clonal expansions of liver cells more ready to proliferate due to beginning chromatin alterations. Their tissue architecture is rarely optimal, with proper portal tracts, sinusoidal capillaries and central vein drainage. They will provide mainly functional hepatocyte mass, leading to good synthetic properties of the liver in terms of albumin, clotting factors and other functional proteins. Due to the suboptimal architecture of the substance exchange between liver and portal capillary blood you expect moderately reduced clearance and homeostatic metabolic functionality.
The key problem is the increased propensity to develop into HCC and frequent US monitoring is essential.
The reduction in liver stiffness is a sure sign of decreased collagen and fibrosis content, with increased functional cell mass and the elimination of the diffusion barrier in the space of disse between capillaries and hepatocytes.
This a very good sign re regaining overall liver functionality, but vascular architecture rebuilding is more limited and might depend on age, length of the cirrhotic stage pre improvement, degree of thrombotic destruction and general health together with persistent stress factors like alcohol, improper food and intestinal health and remaining low grade hepatitis.
At this stage a liver biopsy might be helpful to clarify the tissue qualities of these nodules.
What do you think about reliability of fibroscan.i am afraid that it does t give a correct mesure.i remark that many patient include me done fibroscan but different reading during small period.should we go for biopsy to be sure about the liver conditions?
I saw that the cutoff value for Cirrhosis is 17kpa.
no the risk of cirrhosis starts from low values like 11.5-12.5kpa, maybe the article was about very sure cirrhosis
Stef, if your fibroscan is only 4.5kpa, isn't is clear sign that you improved?
of course but thats fibrosis, not nodules.the liver can work perfectly with nodules too but full reversion of cirrhosis is both fibrosis and histology (nodules).so i would call mine regression until nodules are not cleared
Stef, if your fibroscan is only 4.5kpa, isn't is clear sign that you improved? I saw that the cutoff value for Cirrhosis is 17kpa. I mean does one need to do other tests to see cirrhosis improvement besides fibroscan?