Abstract
OBJECTIVES:Cirrhotic patients must receive an abdominal ultrasound every 6 months as part of hepatocellular carcinoma (HCC) screening. The aim of this study was to assess if HCC screening was performed as recommended by the literature and to observe the differences between the private and public services in Brazil.METHODS:We analyzed data from the HCC screenings of 253 cirrhotic patients from the University Hospital (n=177) and private sector (n=76) in Vitória, ES, Brazil.RESULTS:Ultrasound screening was performed every 13.1 months on average (SD 9.02). In 37 out of 253 patients, the screenings were performed close to the recommended frequency; 16 were performed every 6 months, and 21 were mostly performed during the follow-up period every 6 months. In the remaining 216 cases, ultrasounds were not performed according to the guidelines; for 106 patients, less than 50% of all ultrasounds were performed every 6 months and 110 patients showed an interval greater than one year. Patients from the private sector received ultrasound screenings near the ideal in 28.9% of cases, while patients from the University Hospital received ultrasounds in only 8.4% of cases (p<0.0001). HCC was diagnosed in 30 patients (11.8%). For these 30 patients, 11 screenings were properly performed within 6 months (36.6%) and only 1 out of the 11 (9%) met the criteria for transplant. In the remaining 19 patients who did not receive the screening within 6 months, 6 (31.5%) did not meet the criteria for transplant.CONCLUSION:HCC screening in our environment was irregularly performed, mainly in the public service setting, which prevented early diagnosis in a large number of patients.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and represents more than 90% of all primary liver cancer cases [1,2]
90% of HCC cases are associated with liver cirrhosis, especially those associated with the hepatitis B and C viruses (HBV and HCV, respectively) and alcoholism; any type of cirrhosis is a risk factor for tumor development [1,2]
Despite considerable progress in the treatment of HCC, the prognosis remains poor because most patients present with
Summary
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and represents more than 90% of all primary liver cancer cases [1,2]. HCC screenings in high-risk populations aim to reduce mortality because they may enable the identification of tumors at earlier stages and the use of therapeutic curative measures. It was initially suggested that US screenings should be conducted at 6-month intervals based on tumor doubling times. Shorter time intervals, such as every 3 months, may increase the detection of smaller nodules but have shown no significant effects on survival [5]
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