Ultrasound surveillance for hepatocellular carcinoma of at-risk patients in Ramathibodi Hospital
Prapruttam, D.; Suksai, J.; Kitiyakara, T.; Phongkitkarun, S.
Journal of the Medical Association of Thailand 97(11): 1199-1208
2014
ISSN/ISBN: 0125-2208 PMID: 25675686 Document Number: 16990
Surveillance for hepatocellular carcinoma (HCC) is recommended for patients at risk of developing HCC. However the pattern of surveillance in clinical practice is unclear. To assess the adherence of surveillance program in the detection of HCC and to determine the prevalence of HCC in the at-risk patients who were on surveillance in Ramathibodi Hospital. Retrospective descriptive study of at-risk patients, who were followed in the liver clinic at Ramathibodi Hospital between January 1, 2007 and December 31, 2012. Clinical data were collected from electronic medical records and radiologic data were extractedfrom the radiology database (PACS). The US findings of focal liver lesion were analyzed for number size, location, and echogenicity. When focal liver lesions suggestive of HCC were detected on ultrasonography, dynamic contrast enhanced CT or AMRI was used to diagnose HCC. On CT/MRI, focal lesions were considered to be HCC when hypervascularity in the arterial phase and washout in the portal venous or delayed phase was found Nine hundred seven patients with risk(s) for HCC underwent ultrasound surveillance. The mean number of ultrasound examinations per patient was 4.7±2.2 scans during the course offollow-up. The mean total adherence time was 37.0±17.1 months. The median time interval between each ultrasound examination was 8.4 months (range: 1.1-63.0 months). Focal liver lesions were detected in 161 of 907patients (17.8%). No new focal liver lesion was detected at less than 3-month interval. The majority of patients were evaluatedfurther by MRI (n = 99; 62.3%) or by CT scan (n = 33; 20.8%). Theperiod prevalence of HCC in patients who received US surveillance was 3.5% (32 patients in 907patients). Most ofpatients with HCC were male (71.9%) and the major risk factor was chronic hepatitis B (50.0%). Twenty-one of 32 patients (65.6%) had normal serum AFP levels. Most HCC's (75.0%) were detected at 8-month interval. The cumulative percentage of HCC's detected at 6-month and 12-month surveillance intervals were 11.1% and 70.4%, respectively. The median tumor size was 22.5 mm, ranging from 12-134 mm. At the time ofHCC diagnosis, eight patients (25.0%) had HCC within BCLC very early stage (by size criteria) and 19 patients (59.4%) were in BCLC early stage. Although there were irregular surveillance intervals in our clinical practice, the overall adherence ofpatients to surveillance was acceptable, with the period prevalence of HCC 3.5% and the majority discovered in the early stage.
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