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Difficult Decisions in Hepatobiliary and Pancreatic Surgery pp 93–111Cite as

What Is the Best Way to Screen Cirrhotic Patients for Hepatocellular Carcinoma in the United States?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Hepatocellular carcinoma (HCC) continues to be a significant cause of mortality in the United States. However, HCC is curable if detected early in its course. Cirrhosis is a well-established risk factor for HCC, but direct evidence demonstrating the benefit of screening for HCC in this population remains under contention today. Ultrasound (US) every 6 months is currently the proposed screening methodology. Serum alpha-feto protein (AFP) has been dropped from screening guidelines, yet recent prospective data reported an added efficacy with the combination of serum AFP and US. Technological advances in cross-sectional imaging have dramatically impacted the field of hepatobiliary imaging, making them attractive alternatives for HCC screening in selected populations. While computed tomography (CT) does not appear to confer any significant advantage to US performed by trained personnel, magnetic resonance imaging (MRI) with hepatobiliary phase (HBP) and diffuse weighted imaging (DWI) offers the best sensitivity and specificity for HCC largely due to its superiority in detecting and characterizing lesions <2 cm. Its cost-effectiveness as a screening tool, however, remains to be seen.

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References

  1. Jemal A, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  2. El-Serag HB, et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med. 2003;139(10):817–23.

    Article  PubMed  Google Scholar 

  3. El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology. 2004;127(5 Suppl 1):S27–34.

    Article  PubMed  Google Scholar 

  4. Kim WR, et al. Mortality and hospital utilization for hepatocellular carcinoma in the United States. Gastroenterology. 2005;129(2):486–93.

    Article  PubMed  Google Scholar 

  5. Altekruse SF, et al. Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States. Am J Gastroenterol. 2014;109(4):542–53.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rahib L, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  PubMed  Google Scholar 

  7. Bruix J, Morris S. Management of hepatocellular carcinoma: an update. AASLD Practice Guidelines 2010 [cited 2014 9/17/14]; Available from: http://www.aasld.org/sites/default/files/guideline_documents/HCCUpdate2010.pdf.

  8. Kansagara D, et al. Screening for hepatocellular carcinoma in chronic liver disease: a systematic review. Ann Intern Med. 2014;161(4):261–9.

    Article  PubMed  Google Scholar 

  9. Poustchi H, et al. Feasibility of conducting a randomized control trial for liver cancer screening: is a randomized controlled trial for liver cancer screening feasible or still needed? Hepatology. 2011;54(6):1998–2004.

    Article  PubMed  Google Scholar 

  10. Sarasin FP, Giostra E, Hadengue A. Cost-effectiveness of screening for detection of small hepatocellular carcinoma in western patients with Child-Pugh class A cirrhosis. Am J Med. 1996;101(4):422–34.

    Article  CAS  PubMed  Google Scholar 

  11. Andersson KL, et al. Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol. 2008;6(12):1418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arguedas MR, et al. Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis: a cost-utility analysis. Am J Gastroenterol. 2003;98(3):679–90.

    Article  PubMed  Google Scholar 

  13. Lin OS, et al. Cost-effectiveness of screening for hepatocellular carcinoma in patients with cirrhosis due to chronic hepatitis C. Aliment Pharmacol Ther. 2004;19(11):1159–72.

    Article  CAS  PubMed  Google Scholar 

  14. Mourad A, et al. Hepatocellular carcinoma screening in patients with compensated hepatitis C virus (HCV)-related cirrhosis aware of their HCV status improves survival: a modeling approach. Hepatology. 2014;59(4):1471–81.

    Article  PubMed  Google Scholar 

  15. Patel D, et al. Cost-effectiveness of hepatocellular carcinoma surveillance in patients with hepatitis C virus-related cirrhosis. Clin Gastroenterol Hepatol. 2005;3(1):75–84.

    Article  PubMed  Google Scholar 

  16. European Association For The Study Of The, L, R. European Organisation For, C. Treatment Of. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

  17. Naimark D, Naglie G, Detsky AS. The meaning of life expectancy: what is a clinically significant gain? J Gen Intern Med. 1994;9(12):702–7.

    Article  CAS  PubMed  Google Scholar 

  18. Laupacis A, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992;146(4):473–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Ascha MS, et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51(6):1972–8.

    Article  PubMed  Google Scholar 

  20. Kim Y, et al. Temporal trends in population-based death rates associated with chronic liver disease and liver cancer in the United States over the last 30 years. Cancer. 2014;120(19):3058–65.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen JG, et al. Screening for liver cancer: results of a randomised controlled trial in Qidong, China. J Med Screen. 2003;10(4):204–9.

    Article  PubMed  Google Scholar 

  22. Gambarin-Gelwan M, et al. Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation. Am J Gastroenterol. 2000;95(6):1535–8.

    Article  CAS  PubMed  Google Scholar 

  23. Lok AS, et al. Des-gamma-carboxy prothrombin and alpha-fetoprotein as biomarkers for the early detection of hepatocellular carcinoma. Gastroenterology. 2010;138(2):493–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Marrero JA, et al. Alpha-fetoprotein, des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma. Gastroenterology. 2009;137(1):110–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Trevisani F, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol. 2001;34(4):570–5.

    Article  CAS  PubMed  Google Scholar 

  26. Singal AG, et al. Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis. Cancer Epidemiol Biomark Prev. 2012;21(5):793–9.

    Article  Google Scholar 

  27. Snowberger N, et al. Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis. Aliment Pharmacol Ther. 2007;26(9):1187–94.

    Article  CAS  PubMed  Google Scholar 

  28. Bruix J, Sherman M, D. American Association for the Study of Liver. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lee E, et al. Improving screening for hepatocellular carcinoma by incorporating data on levels of alpha-fetoprotein, over time. Clin Gastroenterol Hepatol. 2013;11(4):437–40.

    Article  CAS  PubMed  Google Scholar 

  30. Takashima T, et al. Diagnosis and screening of small hepatocellular carcinomas. Comparison of radionuclide imaging, ultrasound, computed tomography, hepatic angiography, and alpha 1-fetoprotein assay. Radiology. 1982;145(3):635–8.

    Article  CAS  PubMed  Google Scholar 

  31. Colli A, et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006;101(3):513–23.

    Article  CAS  PubMed  Google Scholar 

  32. Singal A, et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther. 2009;30(1):37–47.

    Article  CAS  PubMed  Google Scholar 

  33. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med. 2014;11(4):e1001624–e1001624.

    Google Scholar 

  34. Trinchet J-C, et al. Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities. Hepatology. 2011;54(6):1987–97.

    Article  PubMed  Google Scholar 

  35. Wang J-H, et al. Hepatocellular carcinoma surveillance at 4- vs. 12-month intervals for patients with chronic viral hepatitis: a randomized study in community. Am J Gastroenterol. 2013;108(3):416–24.

    Article  PubMed  Google Scholar 

  36. Zhang B-H, Yang B-H, Tang Z-Y. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130(7):417–22.

    Article  PubMed  Google Scholar 

  37. Bolondi L, et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut. 2001;48(2):251–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Di Martino M, et al. Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging. Eur Radiol. 2013;23(4):887–96.

    Article  PubMed  Google Scholar 

  39. Henrion J, et al. Surveillance for hepatocellular carcinoma: compliance and results according to the aetiology of cirrhosis in a cohort of 141 patients. Acta Gastroenterol Belg. 2000;63(1):5–9.

    CAS  PubMed  Google Scholar 

  40. Pocha C, et al. Surveillance for hepatocellular cancer with ultrasonography vs. computed tomography – a randomised study. Aliment Pharmacol Ther. 2013;38(3):303–12.

    Article  CAS  PubMed  Google Scholar 

  41. Sangiovanni A, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance☆. Gastroenterology. 2004;126(4):1005–14.

    Article  PubMed  Google Scholar 

  42. Choi BI. The current status of imaging diagnosis of hepatocellular carcinoma. Liver Transpl. 2004;10(2 Suppl 1):S20–5.

    Article  PubMed  Google Scholar 

  43. Boone JM. Multidetector CT: opportunities, challenges, and concerns associated with scanners with 64 or more detector rows. Radiology. 2006;241(2):334–7.

    Article  PubMed  Google Scholar 

  44. Luca A, et al. Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol. 2010;20(4):898–907.

    Article  PubMed  Google Scholar 

  45. United Network for Organ Sharing. HRSA/OPTN Policy 3.6 organ distribution: allocation of livers. Table 9–3: recommendations for dynamic contrast-enhanced CT of liver. Available at: http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_8.pdf. Accessed on 10 Oct 2014.

  46. Addley HC, et al. Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation. Clin Radiol. 2011;66(4):349–56.

    Article  CAS  PubMed  Google Scholar 

  47. Denecke T, et al. Multislice computed tomography using a triple-phase contrast protocol for preoperative assessment of hepatic tumor load in patients with hepatocellular carcinoma before liver transplantation. Transplant Int. 2009;22(4):395–402.

    Article  Google Scholar 

  48. Ronzoni A, et al. Role of MDCT in the diagnosis of hepatocellular carcinoma in patients with cirrhosis undergoing orthotopic liver transplantation. AJR Am J Roentgenol. 2007;189(4):792–8.

    Article  PubMed  Google Scholar 

  49. United Network for Organ Sharing. HRSA/OPTN Policy 3.6 organ distribution: allocation of livers. Table 1. Available at: http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_8.pdf. Accessed 10 Oct 2014.

  50. Barr DC, Hussain HK. MR imaging in cirrhosis and hepatocellular carcinoma. Magn Reson Imaging Clin N Am. 2014;22(3):315–35.

    Article  PubMed  Google Scholar 

  51. Lim KS. Diffusion-weighted MRI of hepatocellular carcinoma in cirrhosis. Clin Radiol. 2014;69(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  52. Liu X, et al. Gadoxetic acid disodium-enhanced magnetic resonance imaging for the detection of hepatocellular carcinoma: a meta-analysis. PLoS ONE. 2013;8(8):e70896–e70896.

    Google Scholar 

  53. Seale MK, et al. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics. 2009;29(6):1725–48.

    Article  PubMed  Google Scholar 

  54. Taouli B, Koh D-M. Diffusion-weighted MR imaging of the liver. Radiology. 2010;254(1):47–66.

    Article  PubMed  Google Scholar 

  55. Bartolozzi C, et al. Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging. 2013;38(2):290–6.

    Article  PubMed  Google Scholar 

  56. Bolondi L, et al. Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology. 2005;42(1):27–34.

    Article  PubMed  Google Scholar 

  57. Hanna RF, et al. Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics. 2008;28(3):747–69.

    Article  PubMed  Google Scholar 

  58. Sun HY, et al. Gadoxetic acid-enhanced magnetic resonance imaging for differentiating small hepatocellular carcinomas (< or =2 cm in diameter) from arterial enhancing pseudolesions: special emphasis on hepatobiliary phase imaging. Investig Radiol. 2010;45(2):96–103.

    Article  CAS  Google Scholar 

  59. Vandecaveye V, et al. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Eur Radiol. 2009;19(10):2456–66.

    Article  PubMed  Google Scholar 

  60. Xu P-J, et al. Added value of breath hold diffusion-weighted MRI in detection of small hepatocellular carcinoma lesions compared with dynamic contrast-enhanced MRI alone using receiver operating characteristic curve analysis. J Magn Reson Imaging. 2009;29(2):341–9.

    Article  PubMed  Google Scholar 

  61. Hwang J, et al. Pre-transplant diagnosis of hepatocellular carcinoma by gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging. Liver Transpl. 2014;20(12):1436–46.

    PubMed  Google Scholar 

  62. Park MJ, et al. Validation of diagnostic criteria using gadoxetic acid-enhanced and diffusion-weighted MR imaging for small hepatocellular carcinoma (<= 2.0 cm) in patients with hepatitis-induced liver cirrhosis. Acta Radiol. 2013;54(2):127–36.

    Article  PubMed  Google Scholar 

  63. Park MJ, et al. Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns. Radiology. 2012;264(3):761–70.

    Article  PubMed  Google Scholar 

  64. Nguyen MH, et al. Racial differences in effectiveness of alpha-fetoprotein for diagnosis of hepatocellular carcinoma in hepatitis C virus cirrhosis. Hepatology. 2002;36(2):410–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Arizona, 1501 N. Campbell Avenue, Rm 6309A, 245136, Tucson, AZ, 85724, USA

    Archita P. Desai

  2. University of Chicago Medical Center, 5841 S. Maryland Ave., MC 7120, Chicago, IL, 60615, USA

    Helen S. Te

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  1. Archita P. Desai
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  2. Helen S. Te
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Correspondence to Helen S. Te .

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Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Desai, A.P., Te, H.S. (2016). What Is the Best Way to Screen Cirrhotic Patients for Hepatocellular Carcinoma in the United States?. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_9

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_9

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