Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

Abstract

Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multislice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.

Ultrasound Imaging of Liver Tumors – Current Clinical Applications

“…The examination has an acceptable sensitivity which increases with the tumor size. Sensitivity varies between 42% for lesions <1 cm and 95% for tumors larger than 1 cm, and specificity can reach 90% (Andreana et al, 2009). Optimal time interval for ultrasound screening of "at risk" population is 6 months as it results from clinical trials that investigated the tumor size doubling time (Bruix, 2005;Maruyama et al, 2008).…”

“…There are studies showing that between 59-94% of newly diagnosed liver nodules in cirrhotic patients have malignant histology and up to 50% of hyperechoic lesions, with ultrasound appearance of hemangioma, ultimately prove to be hepatocellular carcinoma. Therefore, current practice in many centers considers that any new lesion revealed in a cirrhotic patient should be regarded as malignant until otherwise proven (Andreana et al, 2009). There are three categories of cirrhotic liver nodules: regenerative, dysplastic (considered as premalignant conditions) and tumoral (HCC) (Int WP, 1995).…”

Current Trends and Recent Advances in Diagnosis, Therapy, and Prevention of Hepatocellular Carcinoma

“…The potential benefit of combining US with AFP for detection of early stage HCC was reported in the previously mentioned meta-analysis by Singal et al (2009). Therefore, the combination of AFP and US is indeed an indispensable method for the surveillance of HCC in patients with cirrhosis (Andea et al, 2009).…”

Hepatocellular carcinoma detected by regular surveillance: Does timely confirmation of diagnosis matter?

“…Surprisingly, their prognosis was not worse than other patients despite a median 6.5-month period from ultrasonography to recall procedures. This might be explained by the situation in which many benign tumors including hemangioma or regeneration/dysplastic nodules would share the ultrasonographic features of early HCC [15]; in this case, the majority of recall procedures would be negative despite some early malignancy were unable to excluded solely by ultrasonography. Besides, this Group might contain few patients who did not receive a timely confirmation study that might have been done earlier.…”