Current issues and future trends in surveillance for hepatocellular carcinoma.

Abstract

alone (P < 0.001), with minimal loss in specificity. The variable effectiveness of ultrasound may be related to differences in operator experience and technique, with many patients in the United States receiving their ultrasound examinations in local community centers instead of tertiary care centers. Furthermore, the ability of ultrasound to accurately visualize the liver in patients with morbid obesity or a very nodular liver may be impaired. In contrast to current guidelines, these studies suggest that AFP may play an important role in HCC surveillance among patients with cirrhosis. It is clear that better surveillance tools, including more accurate biomarkers or more cost-effective advanced imaging with low or no risk of radiation, are necessary to help improve the sensitivity of finding tumors at an early stage. Des-c carboxyprothrombin (DCP) and lectin-bound AFP (AFP-L3%) are two potential biomarkers that have been proposed. In a nested case-control study among patients in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, DCP and AFP had sensitivities of 74% and 61%, respectively, for HCC at any stage, which was increased to 91% by using the two markers in combination. 8 However, AFP was demonstrated to be more sensitive than DCP and AFP-L3% for the diagnosis of early HCC in a large, multicenter case-control study. 9 Further studies are necessary to better evaluate the role of new biomarkers, including AFP-L3% and DCP, prior to their routine use in clinical practice. Some studies have proposed that computed tomography (CT) or magnetic resonance imaging (MRI) may be more sensitive as alternative imaging studies for the detection of HCC. A systematic review found that the sensitivity of CT for HCC at any stage was 68% (95% confidence interval [CI], 55%-80%) and that of MRI was 81% (95% CI 70%