Poor sensitivity of sonography in detection of hepatocellular carcinoma in advanced liver cirrhosis: accuracy of pretransplantation sonography in 118 patients

Liu, Wei Chiang; Lim, Jae Hoon; Park, Cheol Keun; Kim, Min Ju; Kim, Seung Hoon; Lee, Soon Jin; Lee, Won Jae; Lim, Hyo Keun

doi:10.1007/s00330-002-1814-3

Cited by 51 publications

(52 citation statements)

References 17 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%

“…256 Other teams have found a similar correlation between tumour size and ultrasound sensitivity. 258,259,261 The technology of ultrasound diagnosis is evolving rapidly; it is anticipated that advances such as microbubble contrast enhancement and harmonic imaging techniques will significantly improve early detection rates in coming years. [263][264][265][266] There is also a possibility that these developments will raise false-positive findings.…”

Section: Ultrasonographymentioning

confidence: 99%

“…The two Korean papers were also discounted, as neither provides any evidence on the detectability of larger HCCs: no tumours in Kim and colleagues' series 257 exceed 5 cm in diameter and, although Liu and co-workers 258 found tumours of up to 16 cm, available analyses only refer to tumours larger than 2 cm. Rode and colleagues' findings 261 are based on a small sample (43 liver explants, with HCC in six) and, owing to the exclusion of nodules smaller than 8 mm, the study almost certainly overestimates the capacity of ultrasound for detecting small HCCs.…”

Section: Ultrasound Examinationmentioning

confidence: 99%

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

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

148

108

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. Declared competing interests of authors: K Stein received an unrestricted grant from Schering Plough (UK) to carry out work on the cost-effectiveness of combination therapy for hepatitis C in 2000. KS is also a member of the editorial board for Health Technology Assessment, but he was not involved in the editorial process for this report. M Cramp sits on hepatitis C advisory boards for Schering Plough, Gilead and Roche. He has received unrestricted educational grants from Roche and Schering Plough to support research and service development. He has been awarded an NHS R&D grant looking at injecting drug users who do not have hepatitis C virus infection. J Thompson Coon received a grant from the Hepatitis C Trust to conduct a systematic review of complementary and alternative therapies for the treatment of chronic hepatitis C. HTA Published September 2007This report should be referenced as follows: NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) programme, now part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, man...

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“…The sensitivity of US for the detection of HCC is directly related to tumor size. Its diagnostic sensitivity for tumors smaller than 1 cm is about 42% (7,8) and reaches 95% for tumors of larger size (9). To confirm the suspicion of HCC by US in a patient with cirrhosis of the liver, the use of computed tomography (CT) is suggested (9).…”

Section: Introductionmentioning

confidence: 99%

Differentially Expressed Genes between Early and Advanced Hepatocellular Carcinoma (HCC) as a Potential Tool for Selecting Liver Transplant Recipients

Mas

Maluf

Archer

et al. 2006

Mol Med

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Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. Liver transplantation (LT) represents a curative treatment for "small" HCC. Preoperative staging is critical in selecting optimal candidates for LT to optimize the use of this scarce resource. From December 1997 to February 2004, 148 patients diagnosed with cirrhosis and HCC were evaluated at our center. After staging, the patients were listed for LT according to United Network for Organ Sharing (UNOS) criteria. When pretransplant liver MRIs were compared with the findings of the explanted livers, 8 of 35 patients (22.8%) were understaged. Three of the 8 patients (37.5%) had recurrence post-LT. A retrospective gene expression profiling study was done using microarray technology for tumor samples in the pretransplant hepatitis C virus (HCV)-HCC understaged patients and in a contemporaneous group of HCV-HCC patients that were accurately staged. Two sample t tests comparing the early versus advanced HCV-HCCs with respect to gene expression showed an important set of genes differentially expressed among the samples. Hierarchical clustering analysis of the gene expression profiling classified 93.8% of the total tumor samples and 85.7% of the understaged samples in concordance with the explanted pathological staging. We found a distinctive pattern of gene expression between early and advanced HCV-HCCs. These results suggest that gene expression profiling could improve the pre-LT HCC staging to more closely mimic the explant pathology. Whether gene expression profiling of HCC will be refined to the point of predicting potential metastatic biologic behavior to predict post-LT recurrence will require longitudinal prospective study of this gene array technology.

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Poor sensitivity of sonography in detection of hepatocellular carcinoma in advanced liver cirrhosis: accuracy of pretransplantation sonography in 118 patients

Cited by 51 publications

References 17 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

Differentially Expressed Genes between Early and Advanced Hepatocellular Carcinoma (HCC) as a Potential Tool for Selecting Liver Transplant Recipients

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