HCC Detection on Surveillance US

Abstract

Objective Focused US examinations of the liver in the routine hepatocellular carcinoma (HCC) screening reduce the time spent on evaluating other structures deemed irrelevant to the clinical setting. It is still unknown, however, if such a strategy may additionally improve the frequency of nodules detection. We aimed to assess the impact of an HCC surveillance program in high‐risk patients by means of targeted liver US following LI‐RADS technical guidelines in comparison to a complete upper abdominal scan. Methods In this IRB‐approved, single‐center, prospective study, patients at high‐risk for HCC enrolled from 06/2016 to 09/2019 were randomly assigned to 1 of the 2 institutional protocols: Group A (targeted liver US) or Group B (complete upper abdominal scan). Twenty examiners with similar experience in abdominal US were randomly assigned to perform the examinations exclusively in 1 of the groups (10 in each group). Frequency of hepatic nodules between groups was compared by using Fisher's exact test. Results Four hundred and sixty‐five patients were enrolled, with no significant differences in both groups regarding sex, age, etiology of liver disease, MELD scores, and alpha‐fetoprotein levels. A significantly higher frequency of nodules detection was found in Group A (230 patients; 23 nodules detected; 10% of the sample) in comparison to Group B (235 patients; 3 nodules; 1.3% of the sample) (p <.001). Five patients in Group A and 1 in Group B were positive for HCC after full diagnostic work‐up. Conclusion Adopting an HCC screening program based on targeted liver US improved the detection of hepatic nodules among high‐risk individuals.

Current status of ultrasonography in national cancer surveillance program for hepatocellular carcinoma in South Korea: a large-scale multicenter study

“…In South Korean tertiary hospitals, gastroenterologists actively participate in HCC screening, whereas globally, surveillance USG is primarily performed by radiology departments. 13 In the long term, it will be necessary to pay much attention to USG education in gastroenterology. Regular visits with specialists, such as hepatologists, can effectively increase patient adherence.…”

Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis

“…1). The studies included were conducted in Canada [28], South Korea [19,29], and the USA [3,[30][31][32][33][34][35]. A total of 7,131 patients were included in our analysis, of which 3,649 patients had cirrhosis.…”

“…A total of 7,131 patients were included in our analysis, of which 3,649 patients had cirrhosis. A total of seven studies provided data on liver visualization limitations in US [3,28,29,[31][32][33][34], four in aMRI [19,30,31,35], and one in complete MRI [19]. One study provided data on the quality of liver visualization for both US and aMRI [31], and one study provided data for both aMRI and complete MRI [19].…”

Current and Emerging Tools for Hepatocellular Carcinoma Surveillance

“…(43) The LI-RADS detection score designations (US-1, obviously benign observations or no observations; US-2, non-definitely benign observations <10 mm in diameter; and US-3, non-definitely benign observations ≥10 mm or new portal vein thrombosis) offer guidance on the need for additional imaging or more frequent surveillance, whereas the visualization score provides granularity on the imaging limitations (e.g., body habitus, bowel gas) that may change the sensitivity of detection of focal lesions. Although there are currently no recommendations for management based on LI-RADS visualization scores, early multicenter studies have validated the overall approach of the LI-RADS criteria, (44)(45)(46) and prospective studies are ongoing.…”