Abstract
Hepatocellular carcinoma (HCC) is probably the epitome of a screening target, with a well-defined high-risk population, accessible screening methods, and multiple curative-intent treatments available for early disease. Per major societies guideline consensus, biannual ultrasound (US) surveillance of the at-risk patients is the current standard of care worldwide. Yet, despite its documented success in the past decades, this standard is far from perfect. While the whole community is working to further tighten the knots, a worrying number of cases still slip through this safety net. Consequently, these patients lose their chance to a curative solution which leads to a high disease burden with disproportionate mortality. While US will probably remain the fundamental staple in the screening strategy, key questions are seeking better answers. How can its caveats be addressed, and the technique be improved? When are further steps needed? How to increase accuracy without giving up on accessibility? This narrative review discusses the place of US surveillance in the bigger HCC picture, trying to navigate through its strengths and limits based on the most recent available evidence.
Highlights
3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy, Paediatric Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Abstract: Hepatocellular carcinoma (HCC) is probably the epitome of a screening target, with a well-defined high-risk population, accessible screening methods, and multiple curative-intent treatments available for early disease
New data has shown that patients diagnosed and treated in the earliest Barcelona Clinic Liver Cancer (BCLC)—0 stage had an 86.2% 5-year survival, with a significant decrease in survival with upstaging
The use of tumor markers alone is currently not recommended for hepatocellular carcinoma (HCC) screening, but the combination of AFP and B-mode US is endorsed
Summary
As of 2020, hepatocellular carcinoma (HCC) represents a major cause of morbidity and mortality, especially among patients with chronic liver disease. Available reports rank primary liver cancer as the sixth most common type of malignancy, disproportionally accounting for the fourth place in cancer-related mortality [1] While these figures appear to be relatively stable throughout the recent years, the field is facing unprecedented effervescence, with rapid shifts occurring on multiple levels of knowledge. A meta-analysis of 47 observational studies found that surveillance improved detection of early-stage HCC (odds ratio [OR]2.08), increased curative treatment rates (OR-2.24), and improved survival (OR-1.90), but there are several potential caveats [10]. In this light, the strength of the evidence supporting these screening programs remains disputable, especially with regards to mortality [11]. Data suggest that less than half of patients with cirrhosis are regularly followed-up in specialized hepatology units, which places an increased burden on primary care providers to stay knowledgeable and updated with the diagnostic and therapeutic approach to an already complex issue [22]
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