The role of imaging in the surveillance and diagnosis of hepatocellular cancer

Dulku, Gurjeet; Dhillon, Ravinder; Goodwin, Mark; Cheng, Wendy; Kontorinis, Nickolas; Mendelson, Richard

doi:10.1111/1754-9485.12568

Cited by 18 publications

(18 citation statements)

References 71 publications

(150 reference statements)

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“…US is an efficient tool in terms of cost-effectiveness and ease of accessibility. However, US has a number of drawbacks, including limited depth penetration, poor sensitivity for detecting small lesions, and an inability to assess the entire liver [ 3 , 20 ]. The efficacy of US is also operator-dependent and can be affected by several patient characteristics, such as obesity, a fatty liver, and macronodular cirrhosis [ 2 , 13 , 14 , 29 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Kim

Choi

et al. 2017

BMC Cancer

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BackgroundUltrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis.MethodsMAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period.DiscussionMAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients.Trial registrationThe date of trial registration (NCT02551250) in this study was September 15, 2015, and follow-up is still ongoing.

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Section: Discussionmentioning

confidence: 99%

“…Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second leading cause of cancer-related death [ 1 ]. Cirrhosis is the most significant risk factor for the development of HCC [ 2 , 3 ]. The prognosis of HCC depends on the disease status at the time of diagnosis [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Kim

Choi

et al. 2017

BMC Cancer

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“…Ultrasound contrast agents ("microbubbles") comprise an albumen or phospholipid shell containing a stable perfluorocarbon or sulphur hexafluoride gas. They are predominantly blood-pool agents, as the encapsulated microbubbles are small enough to pass through both pulmonary and systemic circulation after intravenous injection and durable enough to re-circulate for several minutes [13] . CEUS can also be utilized in the presence of renal impairment and can be performed at the time in which the lesion is discovered but it does not eliminate the need for CT and/or MRI in order to characterize the lesion and to stage the disease [14] .…”

Section: Ultrasonography and Contrast-enhanced Ultrasonographymentioning

confidence: 99%

Diagnostic imaging for hepatocellular carcinoma

Santis¹,

Gallusi²

2019

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Hepatocellular carcinoma (HCC) occurs mostly in individuals with cirrhosis, which is why the guidelines of the most important scientific societies indicate that these patients are included in surveillance programs through the repetition of an ultrasound examination every 6 months. The aim is to achieve early identification of the neoplasia in order to increase the possibility of curative therapies (liver transplantation, surgery or local ablative therapies) and to increase patient survival. HCC nodules arising in cirrhotic livers show characteristic angiographic behavior that can be evaluated with dynamic multidetector computed tomography and dynamic magnetic resonance imaging (MRI). However, the use of these techniques in real life is often hindered by the lack of uniform terminology in reporting and in the interpretation of the exams reflected in the impossibility of comparing examinations performed in different centers and/or at different times. Liver Imaging Reporting and Data System® was created to standardize reporting and data collection of computed tomography and MRI for HCC. In some cases HCC arises in patients with healthy livers and, although there is evidence that angiographic behavior is not different from cirrhotic patients in this clinical situation, the guidelines still indicate the execution of a biopsy. Frequent use of palliative therapeutic techniques such as transarterial chemoembolization, transarterial radioembolization or administration of antiangiogenic drugs (sorafenib) poses problems of interpretation of the therapeutic response with repercussions on the subsequent choices that have been attempted to resolve with the use of stringent criteria such as Modified Response Evaluation Criteria In Solid Tumors.

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“…Additionally, the ability of ultrasonography to accurately visualize liver tumors in patients with cirrhosis may be impaired as a result of the patient's obesity, blind spots such as the subphrenic space, the coarse echo pattern of liver parenchyma, nodules measuring < 2 cm, or operator inexperience. 33 Therefore, testing can be combined with computed tomography or magnetic resonance imaging, or other measures can be adopted to decrease the risk of missing a finding. 34 Serologic tumor bio markers include AFP, des-gamma-carboxy prot hrombin, the ratio of glycosylated AFP (L3 fraction) to total AFP, alpha-fucosidase, and glypican-3.…”

Section: Tertiary Preventionmentioning

confidence: 99%

Untitled

Etık

Suna²,

Boyacioglu³

2017

Exp Clin Transplant

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More than 600 000 people die from hepatocellular carcinoma each year. Worldwide, research on the disease needs to be intensified in both the medical and pharmaceutical fields, with a focus on providing help to geographic areas where resources are limited. Treatment approaches depend on the stage of the disease at diagnosis and on access to complex treatment regimens. However, advanced disease is not curable, and treating these patients is expensive and only marginally effective for increasing qualityadjusted life-years. Although the Milan criteria are often used to determine which patients will benefit from liver transplantation, many centers have their own criteria for patient selection. According to criteria developed by Başkent University in Ankara, Turkey, patients with hepatocellular carcinoma and a cirrhotic liver but without extrahepatic disease should be candidates for liver transplant when possible, and living-donor liver transplant should be considered as an alternative rescue therapy for many of these patients. Tumor size and number should not be the sole criteria for excluding liver transplant. Although significant vascular invasion and extrahepatic dissemination definitely indicate major tumor dissemination, until sensitive tests for measuring circulating tumor cells are developed, we continue to recommend liver transplant regardless of tumor size and number. Various locoregional therapies for hepatocellular carcinoma are used before transplant to prevent tumor progression and to decrease the risk of recurrence after transplant. In turn, response to locoregional therapy to decrease tumor stage in hepatocellular carcinoma may be an indicator of tumor behavior and may determine a patient's selection for liver transplant. The delivery of healthcare services for hepatocellular carcinoma could be improved by developing centers of excellence. Concentrating medical care in this way can lead to an increased level of expertise so that resections are performed by surgeons who understand liver disease and the limitations of these and other procedures.

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The role of imaging in the surveillance and diagnosis of hepatocellular cancer

Cited by 18 publications

References 71 publications

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol

Diagnostic imaging for hepatocellular carcinoma

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