Screening combo finds HCC in cirrhosis patients

A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis that was primarily associated with chronic hepatitis C, a retrospective study has shown.

At an alpha-fetoprotein (AFP) cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients.

Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Disease recommends that they have liver cancer screening every 6 to 12 months. The CT and MRI are the gold standard in identifying HCC, they are too expensive to employ as a first-line method at the recommended frequency.

The medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and AFP test, and then had a follow-up CT or MRI within six months were examined.

There were 35 cases of HCC in group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive. In the eight false negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had an AFP level lower than 20 ng/mL. In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL. In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had level of more than 400 ng/mL.

In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening. The Mare B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening population.

Screening for HCC cirrhosis is of increasing importance, and defining the most cost-effective method remains unclear. This study presents encouraging data showing that CT or MRI can be avoided in many patients by using AFP and ultrasound screening. The Frank Cardile professor of medicine and surgery and chief of the Center for Liver Disease and Transplantation at Columbia University College of Physician and Surgeon, New York.