Clinical calculator summary
Original 1996 Milan criteria
Clinical calculator summary
Original 1996 Milan criteria
A binary HCC tumor-burden classification based on lesion number, maximum diameter, vascular invasion, and regional nodal or distant spread.
Evidence-based context for fast calculator use
- Purpose:
- Reproduce the original Milan tumor-burden criteria without converting the result into a transplant-candidacy decision.
- Population:
- The original report concerned selected patients with cirrhosis and small hepatocellular carcinomas undergoing liver transplantation.
- Factors:
- Lesion count, Maximum diameter in cm, Evident vascular invasion, Regional nodal or distant extrahepatic spread
- Reference:
- Mazzaferro et al. N Engl J Med. 1996;334:693-699. PMID 8594428.
Milan Criteria
Clinical Context & Background
Single lesion <= 5 cm OR 2-3 lesions each <= 3 cm, AND no evident vascular invasion, AND no regional nodal or distant extrahepatic spread.Reference Data
| Classification | Original 1996 rule | Scope |
|---|---|---|
| Within original Milan tumor-burden criteria | Single lesion <=5 cm OR 2-3 lesions each <=3 cm; invasion and regional nodal/distant spread absent | Tumor-burden classification only |
| Outside original Milan tumor-burden criteria | Any original requirement is not met | Not a blanket transplant contraindication |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use when the original 1996 Milan tumor-burden classification is specifically required for an HCC assessment.
- Confirm lesion count, the largest lesion diameter, evident vascular invasion, and regional nodal or distant extrahepatic spread before entering data.
How To Interpret
- Within criteria requires a single lesion <=5 cm or 2-3 lesions each <=3 cm, with both invasion and spread absent.
- The 5 cm and 3 cm boundaries are inclusive; four or more lesions are outside the original criteria.
What To Do Next
- Use the classification as one component of specialist hepatology, oncology, radiology, surgery, and transplant review.
- Apply current local transplant policy and contemporary staging separately from this historical model.
Limitations
- Does not determine transplant candidacy, listing priority, treatment choice, or contraindication by itself.
- Does not implement expanded, downstaging, allocation, imaging-response, or biomarker-based criteria.
Validated Population
Selected patients with cirrhosis and small hepatocellular carcinomas in the original 1996 transplantation report.
Inclusive boundary example
A single 5.0 cm lesion with no evident vascular invasion and no regional nodal or distant spread is within the original tumor-burden criteria.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed Milan cases passed through visible production controls at the single-lesion 5 cm boundary, just above 5 cm, and the 2-3 lesion 3 cm boundary.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/milan-liver-transplant-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during the route loads and interactions used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/milan-liver-transplant.json.
: Browser input adapter corrected and reverified
- Accepted finite form-normalized numbers and typed lesion, invasion, and spread choices emitted by the public form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- 217/217 independent source-rule, boundary, malformed-input, UI, trace, immutability, and liver-panel parity checks passed.
- Original 1996 Milan tumor-burden criteria only; the overall liver panel remains In review.
: Calculation and scope correction
- Enforced the original inclusive single-lesion 5 cm and 2-3-lesion 3 cm branches, absent evident vascular invasion, and absent regional nodal or distant extrahepatic spread with no defaults or coercion.
- Replaced transplant-candidate and blanket-contraindication labels with careful original tumor-burden classifications and an explicit specialist-assessment limitation.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
Does a result within the Milan criteria mean the patient is a transplant candidate?
No. It describes the original tumor-burden criteria only. Transplant candidacy requires a complete specialist assessment and current local allocation policy.
Are the 5 cm and 3 cm boundaries included?
Yes. A single lesion exactly 5 cm or two to three lesions with the largest exactly 3 cm meets the size branch when invasion and spread are absent.
What does extrahepatic spread include here?
The original report excluded regional lymph-node involvement and distant metastases; this calculator asks for regional nodal or distant extrahepatic spread as one explicit field.
Evidence-based oncology decision support. Verify with clinical guidelines.