Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 4748 (2015)

Ultrasound surveillance for hepatocellular carcinoma: real-life performance in a hepatology outpatient clinic

  • Rahel Susanne Frey
  • Tujana Boldanova
  • Markus Heim
DOI
https://doi.org/10.4414/smw.2015.14200
Cite this as:
Swiss Med Wkly. 2015;145:w14200
Published
15.11.2015

Summary

QUESTIONS: Regular surveillance of patients at risk for hepatocellular carcinoma (HCC) has been recommended by international guidelines and is practiced in many hepatology clinics. However, little is known about the effectiveness and the costs of 6 monthly ultrasound surveillance.

METHODS: Clinical charts, ultrasound reports and reports of additional examinations (computed tomography, magnetic resonance imaging, liver biopsy) were systematically reviewed. The tumour stage of HCC detected in the surveillance programme was compared with stages of patients not surveyed. The number needed to survey to detect a HCC and the costs per detected HCC were calculated.

RESULTS: In the 2-year period 2011–2012, 696 ultrasound examinations in 285 patients were performed in the hepatology outpatient clinic of the University Hospital Basel, Switzerland. Focal lesions were detected by ultrasound in 88 of the 285 patients. Nine of them had a newly diagnosed HCC. All of them were at early stage (Barcelona Clinic Liver Cancer staging 0 or A) and 8 of 9 fulfilled Milan Criteria. In this 2-year surveillance period, the number needed to screen was 32 patients. The calculated costs per detected HCC were 29 701 Swiss francs.

CONCLUSIONS: In this retrospective analysis, HCC surveillance resulted in the detection of HCCs in an early stage. The number needed to screen and the costs of the surveillance are reasonably low.

References

  1. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142:1264–73 e1261.
  2. European Association For The Study Of The L, European Organisation For R, Treatment Of C. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.
  3. Bruix J, Sherman M, American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.
  4. Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010;4:439–74.
  5. Sherman M. Surveillance for hepatocellular carcinoma. Best Pract Res Clin Gastroenterol. 2014;28:783–93.
  6. Poustchi H, Farrell GC, Strasser SI, Lee AU, McCaughan GW, George J. Feasibility of conducting a randomized control trial for liver cancer screening: is a randomized controlled trial for liver cancer screening feasible or still needed? Hepatology. 2011;54:1998–2004.
  7. Kansagara D, Papak J, Pasha AS, O'Neil M, Freeman M, Relevo R, et al. Screening for hepatocellular carcinoma in chronic liver disease: a systematic review. Ann Intern Med. 2014;161:261–9.
  8. TARMED Suisse. 2015 cited; Available from: http://www.tarmedsuisse.ch
  9. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.
  10. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
  11. Bond M, Pavey T, Welch K, Cooper C, Garside R, Dean S, et al. Systematic review of the psychological consequences of false-positive screening mammograms. Health Technol Assess. 2013;17:1–170, v-vi.
  12. Carter SM, Williams J, Parker L, Pickles K, Jacklyn G, Rychetnik L, et al. Screening for Cervical, Prostate, and Breast Cancer: Interpreting the Evidence. Am J Prev Med. 2015.

Most read articles by the same author(s)