Screening for Hepatocellular Carcinoma in Patients With Advanced Cirrhosis

Abstract

In patients with established cirrhosis, the risk of detecting HCC is maximal at the baseline screening (7%). Hepatitis C was the most common etiology for cirrhosis in study. In U.S. patients with established cirrhosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasound or AFP.

Is tumor biopsy necessary?

“…Eleven studies in this systematic review analyzed the accuracy of CT for the diagnosis of HCC [33][34][35]37,40,43,46,[48][49][50][51] (Supporting Table 5). Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard.…”

“…Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard. This wide variation can be explained by the different study designs (a prospective design versus a retrospective design and consecutive patient enrollment versus nonconsecutive patient enrollment).…”

Comparison between intravenous and intraarterial contrast injections for dynamic 3D MRI of liver tumors in the VX2 rabbit model

“…Reported sensitivity values for CT range from 70 -80% (11)(12)(13), and MRI sensitivity of 84% was observed in a study with IV administered contrast agents (9). Thus, the traditional IV method of contrast agent delivery is inadequate for reliably detecting small HCC lesions.…”

Imaging in liver transplantation

“…US plays a specific role in the diagnosis of biliary atresia and in the screening of HCC in cir rhotic patients [17][18][19][20] .…”

“…The identification of a TC sign results in a sensitivity of 80%, a specificity of 98%, a positive predictive value of 94%, a negative predictive value of 94%, and an accuracy of 94% for diagnosing biliary atresia [17] . US is the most common examination for the screening of HCC in cir rhotic patients, usually performed at either 3-, 6-or 12-mo intervals, although the sensitivity and specificity reported in the literature show a wide heterogeneity, ranging from 58% to 89%, and from 75% to 94%, respectively [18][19][20] . On gray-scale US, HCC is predominantly hypoechoic and sometimes isoechoic, with a thin hypoechoic halo corresponding to the tumor capsule.…”