0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Microvascular Invasion in Hepatitis B Virus–Related Hepatocellular Carcinoma Another Step Toward Preoperative Evaluation?

Ernesto Sparrelid, MD1; Marco Del Chiaro, MD, PhD1
[+] Author Affiliations
1Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institute, Stockholm, Sweden
JAMA Surg. 2016;151(4):364. doi:10.1001/jamasurg.2015.4267.
Text Size: A A A
Published online

Extract

The presence of microvascular invasion (MVI) is regarded as an important prognostic factor after resection for hepatocellular carcinoma.1,2 However, both the prognostic value and clinical relevance of MVI are being questioned.3,4 The main reason behind this disagreement lies in the fact that there is no accepted definition of MVI; the disagreement leads to difficulties in comparing the results from different studies. An associated problem is that the definition of MVI is not clearly stated in many publications. Regardless of the debate, the histopathologic presence of MVI does not help in our preoperative evaluation of the patient when selecting the optimal surgical strategy. We therefore read the work of Lei et al5 in this issue of JAMA Surgery with great interest. Previous attempts to create prognostic tools based on radiologic and clinicopathologic factors have failed to achieve broad acceptance.6 Although the limitations of retrospective, single-center studies are present, the work of Lei and colleagues5 provides us with results indicating that their nomogram might serve as an additional instrument for preoperative decision making. Furthermore, even if the statistical analysis behind the nomogram is extensive and meticulous, one concern remains: the specificity rates imply a substantial risk for both false-positive and false-negative predictions. Still, the nomogram is an interesting contribution to the challenging clinical evaluation of these patients. As the authors mention, we agree that it is necessary to evaluate the validity of the nomogram in a prospective, randomized clinical trial, preferably with several expert centers in collaboration.

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

168 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();