September 27, 2008

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

  • 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)

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