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Review
. 2013 Dec 21;19(47):8808-21.
doi: 10.3748/wjg.v19.i47.8808.

Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it?

Edoardo G Giannini  1 , Alessandro Cucchetti  1 , Virginia Erroi  1 , Francesca Garuti  1 , Federica Odaldi  1 , Franco Trevisani  1
Affiliations
Review

Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it?

Edoardo G Giannini et al. World J Gastroenterol. .

Abstract

Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

Keywords: Cost-effectiveness; Hepatocellular carcinoma; Screening; Surveillance; Ultrasonography.

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Figures

Figure 1
Figure 1
Prorok’s postulates: Paradigm of surveillance for early diagnosis of hepatocellular carcinoma.
Figure 2
Figure 2
Recall policy and diagnostic algorithm proposed by the Italian Association for the Study of the Liver for cirrhotic patients with a nodule detected during ultrasound surveillance. 1Note that, since magnetic resonance (MR) or computed tomography (CT) are anyhow needed for staging in the case of hepatocellular carcinoma diagnosis made by contrast-enhanced ultrasonography (CEUS), a pragmatic approach is to perform MR or CT as the first-line imaging technique for diagnosis, and to resort to CEUS when radiological imaging techniques provide inconclusive features (reprinted with permission)[102].
See this image and copyright information in PMC

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