Diagnosis and screening of small hepatocellular carcinomas. Comparison of radionuclide imaging, ultrasound, computed tomography, hepatic angiography, and alpha 1-fetoprotein assay.

Abstract

Twenty-nine small (less than 5 cm) hepatocellular carcinomas in 18 patients were examined by radionuclide imaging (RN), ultrasound (US), computed tomography (CT), hepatic angiography, and serum alpha 1-fetoprotein (AFP) assay. Sensitivity was 39% with RN, 50% with US, 56% with CT, and 94% with angiography, including infusion hepatic angiography (IHA). Lesions larger than 3 cm could be detected by all of these methods; those between 2 and 3 cm were generally shown by US and CT but not RN. IHA was essential for diagnosis of lesions less than 2 cm, which were otherwise difficult or impossible to detect except with angiography. As a screening method, AFP was best, followed by US and CT. The authors recommend using AFP and US to minimize expense and radiation exposure. In questionable cases, IHA should be performed.

Prospective Evaluation of Small Hepatocellular Carcinoma

“…It is not operator dependant like US and can not only define more accurately the extent of the HCC, but it can also better define extra hepatic spread of disease as reported by La Berge. 34 Detectability of small HCC by CT in our data is superior to that of previous reports of Takashima et al 35 This is because of a new generation CT machine and bolus injection of a large amount of contrast medium. Detectability of small HCCs on CT scans will vary depending on the X-ray attenuation of the lesion.…”

Hepatitis B surface antigenaemia and alpha‐foetoprotein detection from dried blood spots: applications to field‐based studies and to clinical care in hepatitis B virus endemic areas

“…There are limitations to performing liver biopsies, particularly in the absence of treatment options. Therefore, in addition to clinical parameters, measurement of serum alpha‐foetoprotein (AFP) [7] and abdominal ultrasonography (US) examination [8,9] remain the two most accessible and reliable methods to identify and diagnose HCC. The reported sensitivity of serum AFP in HCC diagnosis is in the range of 40–80%, with lower values observed in screening studies [10,11,12].…”

Hepatocellular Carcinoma: Update on Diagnosis and Treatment

“…Due to its sensitivity (50-90%) for detect ing tumors as small as 2 cm in diameter, its low cost relative to other imaging modalities, and the absence of radiation exposure, ultra sonography (US) is the standard imaging mo dality for the screening of large populations at risk for HCC [17,18]. In one study, for tumors <3 cm in size, US had a sensitivity of 91.3%, compared with 63.2% for computer ized tomography (CT) scan and 81.8% for angiography.…”

“…In one study, for tumors <3 cm in size, US had a sensitivity of 91.3%, compared with 63.2% for computer ized tomography (CT) scan and 81.8% for angiography. For tumors 3-5 cm in size, US was 92.9% sensitive vs. 81.8 and 89.3% for CT scan and angiography, respectively [17], In another study, CT scan and US were equiv alent (56 vs. 50% sensitivities, respectively), whereas angiography, including infusion he patic angiography, was superior to both (94% sensitivity), and was deemed to be essential for diagnosis of lesions <2 cm in diameter [18].…”