Background: Detection of hepatocellular carcinoma (HCC) in high risk populations has traditionally involved the use of ultrasound (US), followed by computed tomography (CT) or magnetic resonance imaging (MRI) for confirmation of suspected lesions. The aim of our study was to determine, retrospecttively, in an unselected population of patients with cirrhosis, if an initial US could be as accurate as a subsequent CT or MRI in detecting HCC. Methods: 1600 consecutive cases from 2004-2007 in which US was performed for HCC screening were evaluated. 160 were identified which had an initial US followed by CT or MRI within 6 months. This group included 34 cases of HCC and 126 controls without HCC. Results: 26 cases of HCC were correctly identified by US, representing a sensitivity of 76.5%; the mean alpha-fetoprotein (AFP) level was 440.4 ng/dL. The other 8 cases had a false negative US; the mean AFP was 212.4 ng/dL. In 125 controls the mean AFP was 17.14 ng/dL. This group had only 12 patients, or 9.6%, with an AFP greater than 20 ng/dL, and only 1 who had an AFP greater than 400 ng/mL. In this study, the positive predictive value of US for detecting HCC was 96.3%, while the negative predictive value was 94.0%. Combining US with the AFP level, and using a cutoff of 20 ng/dL, the sensitivity was increased to 87.5%. In this series of 160 patients, only 2 patients with HCC had a negative US and normal serum AFP. Conclusion: In combination with regular monitoring of AFP levels, US can eliminate more expensive imaging studies until further investigation by CT or MRI of questionable US results or elevated AFP is necessary, thus reducing the overall cost of monitoring these populations.
Cite this paper
Welch, J. , Shukla, R. , Igbo, N. , Singal, A. , Kazan-Tannus, J. and Soloway, R. (2013) Use of ultrasound as the initial screening exam for hepatocellular carcinoma in high risk populations. Open Journal of Gastroenterology, 3, 148-154. doi: 10.4236/ojgas.2013.32025.
 El-Serag, H.B. (2004) Hepatocellular carcinoma: Recent trends in the United States. Gastroenterology, 127, S27S34. doi:10.1053/j.gastro.2004.09.013
 Altekruse, S.F., McGlynn, K.A. and Reichman, M.E. (2009) Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. Journal of Clinical Oncology, 27, 1485-1491.
 Bruix, J. and Sherman, M. (2010) Management of heaptocellular carcinoma: An update, AASLD practice guidelines. Hepatology, 53, 1-3.
 Llovet, J.M., Burroughs, A. and Bruix, J. (2003) Hepatocellular carcinoma. Lancet, 362, 1907-1917.
 Liu, X., Cheng, Y., Sheng, W., et al. (2010) Clinicopathologic features and prognostic factors in alpha-fetoprotein-producing gastric cancers: Analysis of 104 cases. Journal of Surgical Oncology, 102, 249.
 Gilligan, T.D., Seidenfeld, J., Basch, E.M., et al. (2010) American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. Journal of Clinical Oncology, 28, 3388. doi:10.1200/JCO.2009.26.4481
 Driscoll, D.A. and Gross, S.J. (2009) Professional Practice Guidelines Committee. Screening for fetal aneuploidy and neural tube defects. Genetics in Medicine, 11, 818. doi:10.1097/GIM.0b013e3181bb267b
 Tong, M.J., Sun, H.-E., Hsien, C., et al. (2010) Surveillance for hepatocellular carcinoma improves survival in Asian-American patients with hepatitis B: Results from a community-based clinic. Digestive Diseases and Sciences, 55, 826-835.
 Makuuchi, M., Kokudo, N., Arii, S., et al. (2008) Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatology Research, 38, 37-51.
 Kudo, M. (2010) The 2008 okuda lecture: Management of hepatocellular carcinoma: From surveillance to molecular targeted therapy. Journal of Gastroenterology and Hepatology, 25, 439-452.
 Bruix, J., Sherman, M., Llovet, J.M., et al. (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. Journal of Hepatology, 35, 421-430.
 Zhang, B. and Yang, B. (1999) Combined alpha fetoprotein testing and ultrasonography as a screening test for primary liver cancer. Journal of Medical Screening, 6, 108-110.
 Kamath, P.S., Wiesner, R.H., Malinchoc, M., et al. (2001) A model to predict survival in patients with end-stage liver disease. Hepatology, 33, 464-470.
 Child, C.G. and Turcotte, J.G. (1964) Surgery and portal hypertension. Major Problems in Clinical Surgery, 1, 185.
 Nguyen, M. and Keeffe, E. (2002) Screening for hepatocellular carcinoma. Journal of Clinical Gastroenterology, 35, S86-S91. doi:10.1097/00004836-200211002-00004