Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease

Colli, Agostino; Nadarević, Tin; Miletić, Damir; Giljača, Vanja; Fraquelli, Mirella; Štimac, Davor; Casazza, Giovanni

doi:10.1002/14651858.cd013346.pub2

Cited by 34 publications

(34 citation statements)

References 532 publications

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“…The European Association for the Study of the Liver (EASL) even explicitly opposes the determination of AFP for the reasons given above (19). Nevertheless, according to new meta-analyses, the combination of ultrasound and AFP is a reliable diagnostic approach to detect HCC (7,20). Zhang et al recommended 400 ng/ml AFP protein in terms of sensitivity and specificity, whether AFP is used alone or combined with ultrasound (21).…”

Section: Diagnostic Biomarkersmentioning

confidence: 99%

HCC biomarkers – state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice

et al. 2022

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Hepatocellular carcinoma (HCC) is one of the most common and deadly tumors worldwide. Management of HCC depends on reliable biomarkers for screening, diagnosis, and monitoring of the disease, as well as predicting response towards therapy and safety. To date, imaging has been the established standard technique in the diagnosis and follow-up of HCC. However, imaging techniques have their limitations, especially in the early detection of HCC. Therefore, there is an urgent need for reliable, non/minimal invasive biomarkers. To date, alpha-fetoprotein (AFP) is the only serum biomarker used in clinical practice for the management of HCC. However, AFP is of relatively rather low quality in terms of specificity and sensitivity. Liquid biopsies as a source for biomarkers have become the focus of clinical research. Our review highlights alternative biomarkers derived from liquid biopsies, including circulating tumor cells, proteins, circulating nucleic acids, and exosomes, and their potential for clinical application. Using defined combinations of different biomarkers will open new perspectives for diagnosing, treating, and monitoring HCC.

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Section: Diagnostic Biomarkersmentioning

confidence: 99%

HCC biomarkers – state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice

et al. 2022

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“…We have summarized the sensitivity and specificity of AFP, AFP‐L3, and DCP reported in various meta‐analyses in Table 1 . ( 75 , 88 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ) Moreover, several studies have suggested that a combination of biomarkers is likely the best tool for detection of HCC. In fact, in March 2020, the FDA approved breakthrough device designation for Roche’s Elecsys GALAD score, ( 106 ) which noninvasively uses an algorithmic score that combines gender, age, AFP, AFP‐L3, and DCP biomarker levels to detect early HCC.…”

Section: What Are the Current And Emerging Circulating Biomarkers For Hcc Surveillance?mentioning

confidence: 99%

Current and Emerging Tools for Hepatocellular Carcinoma Surveillance

Adeniji

Dhanasekaran

2021

Hepatol Commun

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Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Early detection of HCC enables patients to avail curative therapies that can improve patient survival. Current international guidelines advocate for the enrollment of patients at high risk for HCC, like those with cirrhosis, in surveillance programs that perform ultrasound every 6 months. In recent years, many studies have further characterized the utility of established screening strategies and have introduced new promising tools for HCC surveillance. In this review, we provide an overview of the most promising new imaging modalities and biomarkers for the detection of HCC. We discuss the role of imaging tools like ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in the early detection of HCC, and describe recent innovations which can potentially enhance their applicability, including contrast enhanced ultrasound, low-dose CT scans, and abbreviated MRI. Next, we outline the data supporting the use of three circulating biomarkers (i.e., alpha-fetoprotein [AFP], AFP lens culinaris agglutinin-reactive fraction, and des-gamma-carboxy prothrombin) in HCC surveillance, and expand on multiple emerging liquid biopsy biomarkers, including methylated cell-free DNA (cfDNA), cfDNA mutations, extracellular vesicles, and circulating tumor cells. These promising new imaging modalities and biomarkers have the potential to improve early detection, and thus improve survival, in patients with HCC. (Hepatology Communications 2021;5:1972-1986).L iver cancer is the sixth most common cancer worldwide and is now the third-leading cause of cancer-related death, behind lung cancer and colorectal cancer. (1) In 2020, more than 900,000 cases of liver cancer were diagnosed globally, with more than 830,000 liver cancer-related deaths, underscoring the high mortality index of this cancer. (1) Hepatocellular carcinoma (HCC) accounts for 75%-85% of primary liver cancers. The global incidence of HCC has increased by more than 75% in the last 30 years, especially in Western countries, (2)(3)(4) and is expected to continue to grow in the near future. Unfortunately, survival rates for patients with HCC in the United States remain dismally low and essentially unchanged over the past 30 years, (5) with only 3%-34% of patients with HCC surviving 5 years after diagnosis. (6) The high HCC mortality rates can be attributed to several factors, with delayed diagnosis of cancer at more advanced stages of disease being an important reason. (2,7,8) HCC typically arises in the background of the cirrhotic liver, where chronic inflammation and fibrosis induce genomic alterations that render the hepatocytes vulnerable to malignant transformation. (9)(10)(11) The presence of cirrhosis is the strongest risk factor for HCC, with 90% of HCCs arising in cirrhotic livers. The

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“…B-mode ultrasound (BMUS) now serves as the first-line imaging modality for tumor detection or follow-up in high-risk patients ( 21 ). The development of contrast-enhanced ultrasound (CEUS) enables real-time visualization of the microcirculation within nodules, thus providing more useful diagnostic information.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Differentiation of Combined Hepatocellular-Cholangiocarcinoma From Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: A Nomogram Based on Ultrasonographic Features and Clinical Indicators

et al. 2022

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ObjectiveTo establish a predictive nomogram to distinguish combined hepatocellular-cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) based on preoperative clinical and ultrasound findings.MethodsA total of 261 patients with pathologically confirmed primary liver cancers (PLCs) were enrolled in this retrospective study, comprising 87 CHCs, 87 HCCs, and 87 ICCs matched by propensity score matching. Patients were randomly assigned to a training cohort and a validation one at the ratio of 7:3. A nomogram integrating ultrasound imaging characteristics and clinical features was established based on the independent risk factors selected by least absolute shrinkage and selection operator (LASSO) regression. The performance of the nomogram was evaluated in the training and validation cohorts in terms of discrimination, calibration, and clinical usefulness.ResultsThe nomogram, consisting of ultrasound imaging features (shape and margin on B-mode ultrasound, enhanced pattern on contrast-enhanced ultrasound) and clinical information [elevated alpha fetoprotein (AFP) level and serum protein electrophoresis (SPE) α1 level], showed promising performance in differentiating CHC from HCC and ICC, with the concordance index (C-index) of 0.8275 and 0.8530 in the training cohort and the validation cohort, respectively. Hosmer–Lemeshow test and the calibration curves suggested good consistency between predictions and observations. High clinical practicability was confirmed by the decision curve analysis.ConclusionsThe nomogram based on clinical and ultrasound imaging characteristics showed good performance in the discrimination of CHC from other subtypes of PLC and would be valuable in clinical decision-making.

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Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease

Cited by 34 publications

References 532 publications

HCC biomarkers – state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice

HCC biomarkers – state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice

Current and Emerging Tools for Hepatocellular Carcinoma Surveillance

Preoperative Differentiation of Combined Hepatocellular-Cholangiocarcinoma From Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: A Nomogram Based on Ultrasonographic Features and Clinical Indicators

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