Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients.

Kim, Chan Kyo; Lim, Jae Hoon; Lee, Won Jae

doi:10.7863/jum.2001.20.2.99

Cited by 138 publications

(86 citation statements)

References 19 publications

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“…Although this is at the pessimistic end of the range of available evidence, it should not be seen as an outlying estimate. Every study that has used an optimal reference standard (explant pathology) to investigate the diagnostic capabilities of US, in this setting, has reported disappointing sensitivity for the tumours p2 cm in diameter: 13.8% (Kim et al, 2001), 22.2% (Rode et al, 2001) and 30.0% (Liu et al, 2003). Even if one was to adopt the most positive estimate available, all robust evidence suggests that US is less sensitive than AFP assay for the detection of the smallest tumours.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: a cost–utility analysis

et al. 2008

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Using a decision-analytic model, we evaluated the effectiveness and cost-effectiveness of surveillance for hepatocellular carcinoma (HCC) in individuals with cirrhosis. Separate cohorts with cirrhosis due to alcoholic liver disease, hepatitis B and hepatitis C were simulated. Results were also combined to approximate a mixed aetiology population. Comparisons were made between a variety of surveillance algorithms using a-foetoprotein (AFP) assay and/or ultrasound at 6-and 12-monthly intervals. Parameter estimates were obtained from comprehensive literature reviews. Uncertainty was explored using one-way and probabilistic sensitivity analyses. In the mixed aetiology cohort, 6-monthly AFP þ ultrasound was predicted to be the most effective strategy. The model estimates that, compared with no surveillance, this strategy may triple the number of people with operable tumours at diagnosis and almost halve the number of people who die from HCC. The cheapest strategy employed triage with annual AFP (incremental cost-effectiveness ratio (ICER): d20 700 per quality-adjusted life-year (QALY) gained). At a willingness-to-pay threshold of d30 000 per QALY the most cost-effective strategy used triage with 6-monthly AFP (ICER: d27 600 per QALY gained). The addition of ultrasound to this strategy increased the ICER to d60 100 per QALY gained. Surveillance appears most cost-effective in individuals with hepatitis B-related cirrhosis, potentially due to younger age at diagnosis of cirrhosis. Our results suggest that, in a UK NHS context, surveillance of individuals with cirrhosis for HCC should be considered effective and cost-effective. The economic efficiency of different surveillance strategies is predicted to vary markedly according to cirrhosis aetiology.

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Section: Interpretation Of Findingsmentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: a cost–utility analysis

et al. 2008

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“…False-positive results are less pervasive: the same studies report specificities in the range 92-98%. [256][257][258][259][260][261][262] There is good evidence that larger lesions are more reliably identified on ultrasonography. In Bennett and co-workers' study, sensitivities for the detection of HCCs of diameter greater than 5 cm, 3-5 cm, 2-3 cm, 1-2 cm and less than 1 cm were 75%, 50%, 20%, 13.6% and 0%, respectively.…”

Section: Ultrasonographymentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

151

108

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“…However, we wanted to determine the accuracy of imaging techniques as they are performed in routine daily practice in our academic tertiary-care medical center, not in the specific setting of a study in which the radiologist most likely would unintentionally have taken more time and effort to interpret imaging results. Retrospective (re)interpretation of results of imaging examinations by one or more radiologists 19,21,30 includes a similar bias that most likely would lead to greater accuracy than is the case in routine daily practice.…”

Section: Imaging Reports and Radiological-pathological Correlationmentioning

confidence: 99%

Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations

Libbrecht

2002

Liver Transplantation

216

133

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Imaging detection and diagnosis of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) in cirrhotic patients is important because the number, size, and type of focal lesions strongly influence patient management. Focal lesions detected by imaging examinations during pretransplantation evaluation were correlated with focal lesions detected during detailed pathological examination of 49 cirrhotic explant livers. Within 6 months before transplantation, color Doppler ultrasonography (US), contrast-enhanced computed tomography (CT), and magnetic resonance (MR) imaging were performed in 94%, 33%, and 55% of patients, respectively. In 2% to 8% of patients, different types of benign focal lesions were present, and a considerable proportion was interpreted as (pre)malignant on imaging examination. US detected only the largest HCCs (patient sensitivity, 40%; specificity, 100%) and no DNs. On a per-patient basis, contrastenhanced CT and MR imaging had poor sensitivity (20% and 27%, respectively) and good specificity (100% and 94%, respectively) for DNs. Patient sensitivity and specificity of both techniques for HCC were reasonable (50% for CT, 70% for MR imaging) and good (79% for CT, 82% for MR imaging), respectively. Neither technique was able to detect smaller (pre)malignant lesions. As a consequence, 10% of patients underwent transplantation, although they exceeded the tumor number limit. Currently used imaging techniques cannot correctly determine the exact tumor burden in some cirrhotic patients. Regular contrast-enhanced MR examination of cirrhotic patients waiting for liver transplantation is the best tool for the early detection of (pre)malignant lesions. (Liver Transpl 2002;8:749-761.)

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Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients.

Cited by 138 publications

References 19 publications

Surveillance of cirrhosis for hepatocellular carcinoma: a cost–utility analysis

Surveillance of cirrhosis for hepatocellular carcinoma: a cost–utility analysis

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations

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