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Hepatocellular Carcinoma Screening Utilising Serum Alpha-Fetoprotein Measurement and Abdominal Ultrasound Is More Effective than Ultrasound Alone in Patients with Non-viral Cirrhosis

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Abstract

Purpose

This study is aimed to determine the performance of alpha-fetoprotein (AFP) as part of hepatocellular carcinoma (HCC) screening in a non-viral cirrhosis population.

Methods

A retrospective audit was conducted of patients with non-viral cirrhosis over a 13 year period managed at a single centre. All patients were investigated routinely for evidence of viral hepatitis; patients with positive results were excluded from analysis. Cirrhosis was defined on basis of clinical, biochemical, and radiological investigations and examinations. All patients underwent HCC screening with 6-monthly AFP measurement and 6–12-monthly upper abdominal ultrasound (US). Diagnosis of HCC was confirmed by biopsy, definitive imaging, or natural disease progression.

Results

Sixty-seven patients were included (49 males, average age 58.7 years). Of 14 patients who developed HCC during the study period, 12 patients had HCC detected via screening. Of the screening diagnosed HCC cases, four (33%) patients had a normal AFP with abnormal surveillance US, three (25%) had raised AFP with normal surveillance US, and five (42%) had concurrent AFP elevation and US abnormality. Patients with raised AFP and normal surveillance US had HCC diagnosed after a progressive rise in AFP precipitated imaging with alternative modalities. Within the 53 patients who remained free of HCC, a raised AFP precipitated additional imaging on 10 occasions. HCC was diagnosed in 12 out of 64 patients over a total of 4292 screening months giving an annual incidence of 3.35%.

Conclusions

Twenty-five percent of HCC occurring in non-viral cirrhosis will be detected earlier using a surveillance program incorporating both AFP and US compared to imaging alone programs.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Eastern Health, 8 Arnold street, Box Hill, Melbourne, Victoria, 3128, Australia

    Thomas Worland

  2. Department of Radiology, Barwon Health, Geelong, Victoria, Australia

    Benjamin Harrison

  3. Department of General Medicine, Barwon Health, Geelong, Victoria, Australia

    Leighton Delmenico

  4. Department of Gastroenterology, Barwon Health, Geelong, Victoria, Australia

    Damian Dowling

Authors
  1. Thomas Worland
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  2. Benjamin Harrison
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  3. Leighton Delmenico
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  4. Damian Dowling
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Corresponding author

Correspondence to Thomas Worland.

Ethics declarations

This research was reviewed and approved by the Barwon Health Ethics Committee, reference number 17/38.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Worland, T., Harrison, B., Delmenico, L. et al. Hepatocellular Carcinoma Screening Utilising Serum Alpha-Fetoprotein Measurement and Abdominal Ultrasound Is More Effective than Ultrasound Alone in Patients with Non-viral Cirrhosis. J Gastrointest Canc 49, 476–480 (2018). https://doi.org/10.1007/s12029-017-0006-y

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  • DOI: https://doi.org/10.1007/s12029-017-0006-y

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