Early detection of hepatocellular carcinoma by real-time ultrasonography. A prospective study

Abstract

For early detection of hepatocellular carcinoma (HCC), real-time ultrasonography (US) was performed prospectively in 528 patients, including 236 with cirrhosis, 81 with chronic hepatitis, 168 asymptomatic hepatitis B surface antigen carriers, and 43 with a family history of HCC. Simultaneous measurement of serum alpha-fetoprotein (AFP) level was also done. In addition, 233 patients had regular controls at 3- to 6-month intervals, with an average follow-up period of 1.4 years. On initial screening, a total of 17 patients were found to have HCC: 13 in the cirrhotic group, 3 in the HCC family group, and 1 in the asymptomatic carriers. Of these HCCs, 7 were smaller than 3 cm, 6 were between 3 to 5 cm, and 4 were larger than 5 cm. In patients with tumors smaller than 5 cm, the AFP levels were normal in 46.2%, between 20 to 400 ng/ml in another 46.2%, and only 7.6% were over 400 ng/ml. On follow-up, another seven patients, all in the cirrhotic group, were found to have HCCs varying from 1.6 to 4.7 cm; three of them had normal serum AFP level. The authors conclude that real-time US is more sensitive than AFP assay in early detection of HCC, and the high-risk subjects should receive this procedure at regular intervals.

Screening for hepatocellular carcinoma

“…23,28,35,36,40,42 This did not translate into a comparable resection rate. In the majority of studies, the overall surgical resection rate varied from 29 to 54%.…”

“…To overcome this problem, surveillance has been extended to include patients with noncirrhotic chronic viral hepatitis as well as those with overt cirrhosis. The overall reported annual detection rate of HCC in surveillance studies, which included individuals with chronic hepatitis in addition to cirrhosis, is 0.8% to 4.1% [34][35][36][37][38][39][40] (Table 1).…”

“…In the majority of studies, the overall surgical resection rate varied from 29 to 54%. 22,[25][26][27][35][36][37]40,42 Failure to undertake hepatic resection was due mainly to age, patient wishes, cirrhosis, and impaired synthetic function or a poor general medical condition. 34,42 The preference for hepatic resection rather than liver transplantation in all the studies was not discussed.…”

Fighting against viral hepatitis: Lessons from Taiwan

“…34 Accordingly, we proposed screening asymptomatic HBsAg carriers, patients with chronic hepatitis, and those with cirrhosis at defined intervals with serum a-fetoprotein and abdominal ultrasonography. 34,35 The screening yielded many patients with small HCC. Because of the smaller tumor size and a better liver function, the resectable cases increased remarkably.…”

“…Because cirrhosis is the most dominant risk factor of HCC, 35,55 HBsAg-positive cirrhosis is an ideal target to explore. Dr. Yun-Fan Liaw led a randomized study showing that lamivudine could reduce the occurrence of HCC in HBsAg-positive patients with cirrhosis.…”