Paolo Del Poggio1, Stefano Olmi2, Francesca Ciccarese2, Mariella Di Marco3, Gian Ludovico Rapaccini4, Luisa Benvegnù5, Franco Borzio6, Fabio Farinati7, Marco Zoli8, Edoardo Giovanni Giannini9, Eugenio Caturelli10, Maria Chiaramonte11, Franco Trevisani12. 1. Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy. Electronic address: paolo.delpoggio@fastwebnet.it. 2. Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy. 3. Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy. 4. Medicina Interna e Gastroenterologia, Università Cattolica, Rome, Italy. 5. Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy. 6. Medicina Interna ed Epatologia, Ospedale Fatebenefratelli, Milano, Italy. 7. Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy. 8. Dipartimento di Scienze Mediche e Chirugiche, Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. 9. Gastroenterologia, Università di Genova, Genova, Italy. 10. Gastroenterologia, Ospedale Belcolle, Viterbo, Italy. 11. Gastroenterologia, Ospedale Negrar, Verona, Italy. 12. Dipartimento di Scienze Mediche e Chirugiche, Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
Abstract
BACKGROUND & AIMS: Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance. METHODS: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm). RESULTS: HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P < .01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC. CONCLUSIONS: Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months.
BACKGROUND & AIMS: Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance. METHODS: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm). RESULTS: HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P < .01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC. CONCLUSIONS: Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months.
Authors: Kristina Tzartzeva; Joseph Obi; Nicole E Rich; Neehar D Parikh; Jorge A Marrero; Adam Yopp; Akbar K Waljee; Amit G Singal Journal: Gastroenterology Date: 2018-02-06 Impact factor: 22.682
Authors: Monica A Konerman; Aashesh Verma; Betty Zhao; Amit G Singal; Anna S Lok; Neehar D Parikh Journal: Liver Transpl Date: 2019-03 Impact factor: 5.799
Authors: Omair Atiq; Jasmin Tiro; Adam C Yopp; Adam Muffler; Jorge A Marrero; Neehar D Parikh; Caitlin Murphy; Katharine McCallister; Amit G Singal Journal: Hepatology Date: 2016-12-19 Impact factor: 17.425
Authors: O Simmons; D T Fetzer; T Yokoo; J A Marrero; A Yopp; Y Kono; N D Parikh; T Browning; A G Singal Journal: Aliment Pharmacol Ther Date: 2016-11-08 Impact factor: 8.171