AASLD guidelines for the treatment of hepatocellular carcinoma

Heimbach, Julie K.; Kulik, Laura; Finn, Richard S.; Sirlin, Claude B.; Abécassis, Michaël; Roberts, Lewis R.; Zhu, Andrew X.; Murad, M. Hassan; Marrero, Jorge A.

doi:10.1002/hep.29086

Cited by 3,346 publications

(3,368 citation statements)

References 95 publications

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“…Nodule biopsy may represent an alternative option, but the invasiveness and risk of complications (e.g., bleeding) strongly limit its usage [21]. Of note, in our series, all noHCCs with increased size at follow-up were high-or lowgrade dysplastic nodules at pathology analysis.…”

Section: Discussionmentioning

confidence: 71%

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

et al. 2018

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Purpose To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. Materials and methods This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). Results On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development. Conclusion Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

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Section: Discussionmentioning

confidence: 71%

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

et al. 2018

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“…Screening modalities consist of the periodic application of diagnostic tools with cost effectiveness which is generally taken into consideration based on the gain of life expectancy and guidelines indicating that an incidence of ≥ 1.5% year would warrant surveillance of HCC in cirrhosis [25,26] . Guidelines including the last updated screening section with data-supported recommendations were selected for the review; recommendations are as follows.…”

Section: Screening Recommendations For Cirrhotic Adultsmentioning

confidence: 99%

“…AASLD does not suggest performing surveillance of patients with Child-Pugh class C cirrhosis unless they are on the transplant waiting list, given the low anticipated survival for these patients. They pointed out some technical remarks regarding screening modalities (US alone or plus AFP), interval (4-8 months) and modification in screening strategy based on etiology of liver diseases or risk stratification models [26] . In the previous guideline (AASLD-2011), ultrasound scanning alone was recommended [27] .…”

Section: From North Americamentioning

confidence: 99%

Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

Yılmaz¹,

Yilmaz²,

Süer³

et al. 2018

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related to worldwide death with a great geographical variation. To be eligible for curative therapy at the time of diagnosis is important. However, the majority of cases are diagnosed at late stages. This can be achieved with applicable screening modalities. Until now, many organizations around the world have developed guidelines according to their own evidence-based data for screening of HCC. The purpose of this article is to review the screening modalities of HCC to assist gastroenterologists and providers involved in the management of HCC.

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“…As local representatives, members representing Society of Gastroenterology, Radiology, Oncology, Pathology and General Surgery, participated in the discussions. Already published European association of study of liver disease guidelines [3], Asia Pacific clinical practice guidelines 2017 [4] and American association of study of liver disease guidelines 2016 [5], were used as a baseline platform. Each point was taken up, discussed and debated prior to an agreement.…”

Section: Hepatitis Screening In Sri Lankan Patientsmentioning

confidence: 99%

SLHPBA Guidelines for the management of hepatocellular carcinoma in Sri Lanka - consensus statement

et al. 2018

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Even though incidence of Hepatitis B is extremely low, it is recommended to continue hepatitis B vaccination which is currently included in the national immunization program. Screening for HCC in Sri Lankaa. Screening for HCC in cirrhotics i. Six-monthly ultrasound scanning is recommended in screening cirrhotic patients.Ÿ It is recommended to use a specially prepared request form within institutions indicating a clear clinical history.b. Screening of high risk NASH groups.i.Diabetics who are older than 40 years with elevated AST/ALT may be subjected to ultrasound scan screening.Ÿ Frequency of screening is to be decided by the clinician as firm data is not yet available. c. Hepatitis screening in Sri Lankan patients.Ÿ Considering the extremely low incidence, screening for hepatitis B and C is likely to yield negative results. Nonavailability or delay in these reports should not delay the management of HCC. d.Place of alpha feto protein (AFP)Ÿ Alpha feto protein has limited value in screening for HCC. Ÿ Alpha feto protein is useful as an adjunct for imaging. Ÿ Alpha feto protein is an important test in prognostication of HCC. Diagnosis of HCC a. Cirrhotic patients

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AASLD guidelines for the treatment of hepatocellular carcinoma

Cited by 3,346 publications

References 95 publications

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

SLHPBA Guidelines for the management of hepatocellular carcinoma in Sri Lanka - consensus statement

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