Journal of Vascular and Interventional Radiology
Screening for Hepatocellular Carcinoma
Section snippets
HIGH-RISK POPULATION
Cirrhosis is the single most important risk factor for HCC throughout the world (3, 4, 5, 6, 7). HBV is the most common risk factor for the development of HCC worldwide (8, 9). Results of prospective and case-controlled studies have shown that HBV carriers are more likely to develop HCC than is the general population, and a universal vaccination for HBV has been shown to decrease the incidence of HCC in children (8, 9, 10, 11, 12). HBV-related HCC is seen predominantly (70%–90%) in patients
α-fetoprotein Level
α-fetoprotein (AFP) is the most commonly used tumor marker for screening. AFP is part of a super-gene family that encodes for many other proteins, including albumin and vitamin D binding protein, and is situated on chromosome 4 (4q11– q13). AFP is synthesized by the yolk sac during early fetal life and by the fetal liver during later fetal life. AFP levels decline rapidly after birth, and elevated levels are seen only in pathologic conditions. The cellular aspects of AFP reexpression in HCC
RADIOLOGIC IMAGING OF HCC
HCC is most commonly seen in patients with advanced cirrhosis, and the real challenge is to diagnose the tumor when it is very small (<2 cm). The commonly used imaging modalities are US, CT, and magnetic resonance (MR) imaging. The use of these modalities will be discussed only briefly in this section because it will be covered in more detail elsewhere. A wide range of sensitivities, specificities, positive predictive values, and negative predictive have been reported in the literature for
US
US is the most widely used imaging modality for screening high-risk patients. Small HCCs (<3 cm) are hypoechoic at US, and larger tumors have an infiltrative mosaic with a complex echogenicity pattern. The presence of a pseudocapsule is highly suggestive of an HCC. The sensitivity of US in the detection of HCC ranges from 35% to 84%, and more objective studies have reported a lower sensitivity of 35%– 59% (57, 58). US is very much operator dependent, and this may explain the conflicting reports
CT
On CT scans, the attenuation of most HCC foci is lower than that of the surrounding liver tissue. Small, welldifferentiated tumors, however, may not have low attenuation, and this may pose a diagnostic dilemma. The use of dynamic helical CT has substantially improved the diagnostic accuracy by enabling imaging of the liver in the arterial, portal venous, and equilibrium phases (69, 70, 71, 72). The portal and equilibrium phases have proved to be very useful in the detection of differentiated,
SCREENING PROTOCOLS
The natural history of HCC is variable. It has been estimated that the doubling time of tumor size may range from 1 to 19 months, with a median of 4–6 months. This is the rationale for screening at 6-month intervals, but many investigators have suggested that, because of the unpredictable tumor growth rate, screening be done more frequently (3-month intervals) in a high-risk population (4, 58). Patients with smaller tumors (<2 cm) have a substantially better prognosis. In a large study (74),
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Cited by (36)
Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival
2016, Journal of HepatologyCitation Excerpt :The largest increase in HCC prevalence occurred among Hispanics followed by blacks and non-Hispanic whites, whereas the lowest increase occurred among Asians (Fig. 2). Differences in underlying etiology of HCC may contribute to the changing racial patterns among the BB cohort, suggesting HCV as the predominant etiology of HCC in blacks, and hepatitis B virus (HBV) as the major etiology of HCC among Asians [6,21–23]. While our current study confirms the increasing prevalence and thus the shifting distribution of HCC towards individuals born between 1945 and 1965 in the U.S. [2,6], birth cohort-specific disparities in disease presentation and treatment outcomes among patients with HCC are not well studied.
Development of hepatocellular carcinomas in patients with absence of tumors on a prior ultrasound examination
2012, European Journal of RadiologyCitation Excerpt :The optimal interval time can be determined based on the doubling time of HCC cells. However, not all HCC cells have the same characteristics: the doubling time of tumor size has been estimated to be a median of 4–6 months by Koteish and Thuluvath [20], 117 days by Sheu et al. [38], and 171.6 days by Barbara et al. [39]. Therefore, the recommended surveillance interval has been suggested to be between 3 months and 1 year [16].
Evaluation of α-fetoprotein (AFP) in human serum by chemiluminescence enzyme immunoassay with magnetic particles and coated tubes as solid phases
2009, Analytica Chimica ActaCitation Excerpt :AFP is the most widely used tumor marker for the diagnosis of hepatocellular cancer (HCC) [1,2].
Diagnosing and monitoring hepatocellular carcinoma with alpha-fetoprotein: New aspects and applications
2008, Clinica Chimica Acta
Neither author has identified a conflict of interest.