Small Nodule Detection in Cirrhotic Livers: Evaluation with US, Spiral CT, and MRI and Correlation with Pathologic Examination of Explanted Liver

Rode, Agnès; Bancel, Brigitte; Douek, Philippe; Chevallier, M.; Vilgrain, Valérie; Picaud, Georges; Henry, Luc; Berger, Françoise; Bizollon, T.; Gaudin, Jean-Louis; Ducerf, C.

doi:10.1097/00004728-200105000-00001

Cited by 271 publications

(200 citation statements)

References 38 publications

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“…The performance of CT and MRI is affected by the size of the lesions [204,205]. Although CT and MRI are reported to have a sensitivity of 60-94.4% and 58.5-93%, respectively, in tumors larger than 1 cm, their sensitivities for detecting tumors smaller than 1 cm are reduced by 33-45 and 33-67%, respectively [204,[206][207][208]. Furthermore, small, arterially enhancing nodules are common in the cirrhotic liver, and majority of these nodules are benign [209][210][211].…”

Section: Ct Mri and Other Imaging Modalitiesmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Section: Ct Mri and Other Imaging Modalitiesmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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“…We conducted a meta-analysis of the sensitivity and specificity of AFP, US, spiral CT and MRI for HCC diagnosis in CHB patients using Meta-Disc (Zamora et al, 2006). A total of 19 studies were considered for the analysis (Maringhini et al, 1984;Okazaki et al, 1984;Kobayashi et al, 1985;Gambarin-Gelwan et al, 2000;Lim et al, 2000;Peterson et al, 2000;Kim, et al, 2001;Krinsky, et al, 2001;Rode et al, 2001;Tong et al, 2001;Trevisani et al, 2001;Bennett et al, 2002;de Ledinghen et al, 2002;Libbrecht et al, 2002;Mori et al, 2002;Zacherl et al, 2002;Bhartia et al, 2003;Burrel et al, 2003;Marrero et al, 2003).…”

Section: Transitional Probabilitiesmentioning

confidence: 99%

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

Sangmala¹,

Chaikledkaew²,

Tanwandee³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. Oneway and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

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“…Eleven studies in this systematic review analyzed the accuracy of CT for the diagnosis of HCC [33][34][35]37,40,43,46,[48][49][50][51] (Supporting Table 5). Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard.…”

Section: Question 3 What Are the Sensitivity And Specificity Of Nonimentioning

confidence: 99%

“…Finally, 9 studies used MRI for the noninvasive diagnosis of HCC 32,40,43,46,48,[52][53][54][55] (Supporting Table 6). In all *The analysis was presented for 3 observers.…”

Section: Question 3 What Are the Sensitivity And Specificity Of Nonimentioning

confidence: 99%

Is tumor biopsy necessary?

et al. 2011

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Small Nodule Detection in Cirrhotic Livers: Evaluation with US, Spiral CT, and MRI and Correlation with Pathologic Examination of Explanted Liver

Abstract: Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.

Cited by 271 publications

References 38 publications

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

Is tumor biopsy necessary?

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