Screening for Hepatocellular Carcinoma in Cirrhotic Patients

Ultrasound image shows a large mixed echoic mass in a cirrhotic patient.

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
  

Notes

• 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%
  

References:

Miller JC, et al. Screening for hepatocellular carcinoma in cirrhotic patients. J Am Coll Radiol 2008 (September 2008)