Which test is good for screening in cirrhotic patients?
- AFP >20 ng/ml -- sensitivity 58%, specificity 91%
- Ultrasound -- sensitivity 20-58%, specificity 92-96%
- CT -- sensitivity 54-85%, specificity 66-96%
- MRI -- sensitivity 44-92%, specificity 57-86%
What is the recommendation?
- Annual or biannual ultrasound combined with serum AFP
- If US is positive, or underlying liver is heterogeneous --> do contrast CT or MRI
- Survival benefit of screening is still not proven, but there are several potential curative Rx available for these patients.
- Ultrasound not sensitive but cost-effective, therefore it becomes a first-line imaging method.
- Annual risk of cirrhotic patients of developing HCC is 1-6%
Miller JC, et al. Screening for hepatocellular carcinoma in cirrhotic patients. J Am Coll Radiol 2008 (September 2008)