Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

Sato, Takahisa; Tateishi, Ryosuke; Yoshida, Haruhiko; Ohki, Takamasa; Masuzaki, Ryota; Imamura, Jun; Goto, Tadashi; Kanai, Fumihiko; Obi, Shuntaro; Kato, Naoya; Shiina, Shuichiro; Kawabe, Takao; Omata, Masao

doi:10.1007/s12072-009-9145-y

Cited by 72 publications

(58 citation statements)

References 30 publications

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“…Ultrasound (US) is the test of choice for surveillance. In fact, US is a cheap and safe test, due to the absence of contrast medium and radioactivity [20][21][22][23] . Moreover, differently from computed tomography (CT) and magnetic resonance (MR), US does not expose to the risk of false positive results.…”

Section: Screening and Recall Policymentioning

confidence: 99%

Management of hepatocellular carcinoma: Enlightening the gray zones

Mancuso¹

2013

WJH

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Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. HCC is a worldwide clinical and social issue and typically a complicates cirrhosis. The incidence of HCC is increasing, not only in the general population of patients with cirrhosis, but particularly in some subgroups of patients, like those with human immunodeficiency virus infection or thalassemia. Since a 3% annual HCC incidence has been estimated in cirrhosis, a bi-annual screening is generally suggested. The diagnostic criteria of HCC has recently had a dramatic evolution during recent years. HCC diagnosis is now made only on radiological criteria in the majority of the cases. In the context of cirrhosis, the universally accepted criteria for HCC diagnosis is contrast enhancement in arterial phase and washout in venous/late phase at imaging, the so called "typical pattern". However, recently updated guidelines slightly differ in diagnostic criteria. Apart from liver transplantation, the only cure of both HCC and underlying liver cirrhosis, all the other treatments have to match with higher rate of HCC recurrence. The latter can be classified into curative (resection and percutaneous ablation) and palliative treatments. The aim of this paper was to review the current knowledge on management of HCC and to enlighten the areas of uncertainty.

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Section: Screening and Recall Policymentioning

confidence: 99%

Management of hepatocellular carcinoma: Enlightening the gray zones

Mancuso¹

2013

WJH

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“…The combination of ultrasound and serum AFP test is the most common method to screen HCC due to its being cost-effective, non-invasive and available globally. However, these tests are limited regarding clinical practice (12)(13)(14)(15)(16)(17)(18)34,36), thus a number of patients are lost. Moreover, differentiating cancer lesions from nodules in cirrhotic patients is challenging.…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of protein induced by vitamin K absence in patients with chronic hepatitis B virus infection

et al. 2012

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Abstract. Hepatitis B virus (HBV) is a leading cause of hepato cellular carcinoma (HCC). α-fetoprotein (AFP) is a common tumor marker for the diagnosis of HCC, although not for protein induced by the absence of vitamin K or antagonist-II (PIVKA-II). The present study aimed to evaluate the role of PIVKA-II in the diagnosis of HCC in HBV-infected Vietnamese patients. A total of 166 consecutive HBV-infected Vietnamese patients were enrolled, including 41 HCC, 43 liver cirrhosis (LC), 26 chronic hepatitis (CH) and 56 asymptomatic carriers (ASC). AFP was examined using ELISA, while PIVKA-II was analyzed using Eitest PIVKA-II. The cut-off level of AFP and PIVKA-II was 20 ng/ml and 40 mAU/ml, respectively. Although the markers, AFP (344±356 ng/ml) and PIVKA-II (16,200±25,386 mAU/ml), were the highest in the HCC groups, only PIVKA-II in HCC was significantly higher compared to the other groups (P<0.001). The univariate analysis demonstrated that age over 50, male, genotype C, AFP and PIVKA-II were risk factors of LC and HCC. Results of the receiver operating characteristics (ROC) analysis showed that PIVKA-II was more sensitive to HCC compared to AFP. Moreover, PIVKA-II was strongly correlated with the portal venous thrombosis in HCC, as opposed to AFP. Results of the multivariate analysis demonstrated that PIVKA-II was the strongest independent risk factor of LC and HCC. In conclusion, PIVKA-II is likely to be a better marker for the diagnosis of HCC in chronic HBV-infected Vietnamese patients. IntroductionVietnam is one of the countries in the Western part of the Pacific-Ocean, with a high rate of hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC). At present, the prevalence of HBV infection in Vietnam is more than 8%, and in some regions it may be up to 25% (1-4). Vietnamese HBV strains share characteristics of mutations in the core promoter and enhancement II region of the X gene in its genome, similar to HBV strains from China, Hong Kong and Japan. These mutations are risk factors for the development of severe liver diseases and HCC (5-8). HBV is the leading cause of HCC in Vietnam, with an incidence only less than that of lung and stomach cancer in males (9,10). Recently, the Vietnamese government has made serious efforts to persuade individuals, particularly parents of neonates, to join the HBV vaccination program nationwide. However, partly due to the living standards and the differences in medical services available in the cities and countryside, and partly due to lack of awareness, not all newborn babies have been vaccinated at present. Serum α-fetoprotein (AFP) is used as a routine test, although magnetic resonance imaging (MRI) and computed tomography (CT) scans are only available in large cities or in major provincial hospitals. Additionally, MRI and CT scans are expensive for ordinary Vietnamese individuals. Ultrasound (US) examination was introduced in Vietnam over 20 years ago, however, good operators are working only in big hospitals at present.The above reasons render HCC a major heal...

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“…50 Triple phase CT (computerized tomogram) or MRI (magnetic resonance imaging) cannot be advocated for routine surveillance due to high cost and radiation exposure. But when a patient is listed for liver transplantation, or in the presence of obesity, ascites and very coarse liver, all of which preclude a good sonological window, CT or MR can be used to investigate for the presence of HCC.…”

Section: Surveillance Strategymentioning

confidence: 99%

Surveillance for Hepatocellular Carcinoma

Ramachandran

2014

Journal of Clinical and Experimental Hepatology

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Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

Cited by 72 publications

References 30 publications

Management of hepatocellular carcinoma: Enlightening the gray zones

Management of hepatocellular carcinoma: Enlightening the gray zones

Clinical utility of protein induced by vitamin K absence in patients with chronic hepatitis B virus infection

Surveillance for Hepatocellular Carcinoma

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