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Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Abdominal ultrasound is a cost-effective method for screening for hepatocellular carcinoma (HCC) in high-risk individuals. Currently, at many institutions the protocol for obtaining HCC screening ultrasounds includes a traditional examination of the right upper quadrant, including the pancreas and right kidney. There is no consensus on the role of imaging of extra-hepatic structures and there are limited data describing the frequency and clinical significance of incidental findings discovered during HCC screening. The purpose of this retrospective study is to assess the prevalence and significance of extra-hepatic incidental findings during HCC screening ultrasounds.

Methods

A single-center retrospective review of all right upper quadrant HCC screening ultrasounds identified 432 HCC screening ultrasounds performed on 294 adults over a 2.5-year period. Findings in all organs evaluated were recorded. Any incidental finding was classified as minor, moderate, or major clinical significance.

Results

At least one extra-hepatic finding was documented in 57.4% of examinations. The most common extra-hepatic findings occurred in the gallbladder (40.3%), most commonly gallstones (25.4%). Four moderate clinically significant incidental findings were recorded (0.9%). Only one of these incidental findings required specific imaging follow up (0.2%). No major clinical significance incidental findings were identified.

Conclusions

Potentially clinically significant incidental findings during ultrasound HCC screenings are rare. Incidental findings identified on HCC screening did not result in significant additional follow-up imaging or interventions.

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References

  1. Zhang BH, Yang BH, Tang ZY (2004) Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 130:417–422. https://doi.org/10.1007/s00432-004-0552-0.

    Article  Google Scholar 

  2. Cucchetti A, Trevisani F, Cescon M, Ercolani G, Farinati F, Poggio PD, Rapaccini G, Nolfo MAD, et al. (2012) Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population. J Hepatol 56:1089–1096. https://doi.org/10.1016/j.jhep.2011.11.022.

    Article  Google Scholar 

  3. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, Roberts LR, Heimbach JK (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750. https://doi.org/10.1002/hep.29913.

    Article  Google Scholar 

  4. Rodgers SK, Fetzer DT, Gabriel H, Seow JH, Choi HH, Maturen KE, Wasnik AP, Morgan TA, et al. (2019) Role of US LI-RADS in the LI-RADS Algorithm. Radiographics 39:690–708. https://doi.org/10.1148/rg.2019180158.

    Article  Google Scholar 

  5. Morgan TA, Maturen KE, Dahiya N, Sun MRM, Kamaya A, American College of Radiology Ultrasound Liver I, Reporting Data System Working G (2018) US LI-RADS: ultrasound liver imaging reporting and data system for screening and surveillance of hepatocellular carcinoma. Abdom Radiol 43:41–55. https://doi.org/10.1007/s00261-017-1317-y.

    Article  Google Scholar 

  6. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 7(10):754–773. https://doi.org/10.1016/j.jacr.2010.06.013.

    Article  Google Scholar 

  7. Lumbreras B, Donat L, Hernandez-Aguado I (2010) Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol 83:276–289. https://doi.org/10.1259/bjr/98067945.

    Article  CAS  Google Scholar 

  8. Samim M, Goss S, Luty S, Weinreb J, Moore C (2015) Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5,383 consecutive examinations. J Am Coll Radiol 12:63–69. https://doi.org/10.1016/j.jacr.2014.07.026.

    Article  Google Scholar 

  9. World Health Organization (2004) ICD-10 : international statistical classification of diseases and related health problems: tenth revision, 2nd ed.

  10. American Medical Association (2022) CPT 2022 Professional Edition.

  11. Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, Glick SN, Laghi A, Macari M, McFarland EG, Morrin MM, Pickhardt PJ, Soto J, Yee J (2005) Working Group on Virtual Colonoscopy. CT colonography reporting and data system: a consensus proposal. Radiology. 236(1):3–9. https://doi.org/10.1148/radiol.2361041926.

  12. Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F (2020) Gallstones top to toe: what the radiologist needs to know. Insights Imaging 11:13. https://doi.org/10.1186/s13244-019-0825-4.

    Article  CAS  Google Scholar 

  13. Richard PO, Violette PD, Jewett MA, Pouliot F, Leveridge M, So A, Whelan TF, Rendon R, et al. (2017) CUA guideline on the management of cystic renal lesions. Can Urol Assoc J 11:E66–E73. https://doi.org/10.5489/cuaj.4484.

    Article  Google Scholar 

  14. Orme NM FJ, Siddiki HA, Harmsen WS, O'Byrne MM, Port JD, Tremaine WJ, Pitot HC, McFarland EG, Robinson ME, Koenig BA, King BF, Wolf SM. (2010) Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 170:1525–1532. https://doi.org/10.1001/archinternmed.2010.317.

    Article  Google Scholar 

  15. Pooler BD, Kim DH, Pickhardt PJ (2017) Extracolonic Findings at Screening CT Colonography: Prevalence, Benefits, Challenges, and Opportunities. AJR Am J Roentgenol 209:94–102. https://doi.org/10.2214/AJR.17.17864.

    Article  Google Scholar 

  16. da Silva PH, Gomes MM, de Matos CAL, de Souza ESIS, Gonzalez AM, Torres US, Salazar GMM, D'Ippolito G (2021) HCC Detection on Surveillance US: Comparing Focused Liver Protocol Using US LI-RADS Technical Guidelines to a General Complete Abdominal US Protocol. J Ultrasound Med 40:2487–2495. https://doi.org/10.1002/jum.15637.

    Article  Google Scholar 

  17. McNaughton DA, Abu-Yousef MM (2011) Doppler US of the Liver Made Simple. RadioGraphics 31:161–188. https://doi.org/10.1148/rg.311105093.

    Article  Google Scholar 

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. University of Vermont Medical Center, Burlington, VT, USA

    Allison Forrest, Sam Afshari, Nathan Franssen & Naiim Ali

  2. Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA

    Allison Forrest

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  1. Allison Forrest
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  2. Sam Afshari
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Correspondence to Allison Forrest.

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Forrest, A., Afshari, S., Franssen, N. et al. Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma. Abdom Radiol 48, 257–262 (2023). https://doi.org/10.1007/s00261-022-03678-z

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  • DOI: https://doi.org/10.1007/s00261-022-03678-z

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