Medical Oncology

, 36:26 | Cite as

Population-based assessment of the national comprehensive cancer network recommendations for baseline imaging of hepatocellular carcinoma

  • Omar Abdel-Rahman
  • Winson Y. CheungEmail author
Original Paper


This analysis aims to evaluate the performance characteristics of alternative baseline imaging thresholds in a cohort of hepatocellular carcinoma (HCC) patients from the Surveillance, Epidemiology, and End Results (SEER) database. HCC patients within the SEER database (2010–2015) who had complete information on clinical T and N stages as well as complete information on metastatic sites were eligible for the current study. Various performance characteristics associated with baseline imaging were investigated, including specificity, sensitivity, positive likelihood ratio (LR), negative LR, number needed to investigate (NNI), negative predictive value (NPV), positive predictive value (PPV), and accuracy. A total of 27,201 HCC patients were included. Based on current recommendations that advocate for the use of cross-sectional chest imaging in all newly diagnosed cases of HCC, these recommendations would yield a PPV of 5.0% for the detection of lung metastases. This would translate to an NNI of 20.0. When T1N0 patients were excluded from routine chest or bone imaging, this resulted in a PPV of 6.8% for the identification of lung metastases and an NNI of 14.7. Likewise, this translated to a PPV of 4.6% for the identification of bone metastases and an NNI of 21.7. Similarly, when patients with T1N0 disease and normal alpha-fetoprotein (AFP) were excluded from routine imaging, this resulted in a PPV of 5.6% for the identification of lung metastases and an NNI of 17.8. Also, this translated to a PPV of 3.8% for the identification of bone metastases and an NNI of 26.3. The current study suggests that the omission of routine baseline chest imaging may be considered in selected patients with asymptomatic early-stage HCC and normal AFP.


HCC Staging NCCN Staging Prognosis 



This study was not funded.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the author.

Informed consent

As this study is based on a publicly available database without identifying patient information, informed consent was not needed.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of OncologyUniversity of Calgary, Tom Baker Cancer CentreCalgaryCanada

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