Hepatocellular carcinoma screening: Difference between revisions
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==Overview== | ==Overview== | ||
"Surveillance is deemed cost-effective if the expected HCC risk exceeds 1.5% per year in patients with hepatitis C and 0.2% per year in patients with hepatitis B. Analysis of recent studies show that alpha-fetoprotein determination lacks adequate sensitivity and specificity for effective surveillance (and for diagnosis). Thus, surveillance has to be based on ultrasound examination. The recommended screening interval is 6 months" according to a [[clinical practice guideline]] by the [http://www.aasld.org/ American Association for the Study of Liver Diseases]. <ref name="pmid21374666"/> | |||
"In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis" according to a [[systematic review]] by the [http://www.hta.ac.uk/ NIHR Health Technology Assessment programme] (UK). <ref name="pmid17767898"/> | |||
==Evidence from trials== | |||
Regarding patients with [[hepatitis B]], a [[meta-analysis]] by the [[Cochrane Collaboration]] concluded "".<ref name="pmid22972059">{{cite journal| author=Aghoram R, Cai P, Dickinson JA| title=Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 9 | issue= | pages= CD002799 | pmid=22972059 | doi=10.1002/14651858.CD002799.pub2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972059 }} </ref> In a [[randomized controlled trial]] included in the meta-analysis, the [[relative risk ratio]] of biannual [[alpha-fetoprotein]] and [[ultrasonography]], as compared to [[no screening]], for mortality from hepatocellular carcinoma was 0.6 and the [[relative risk reduction]] was 36.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality from hepatocellular carcinoma of 0.13% without treatment, the [[number needed to treat]] is 2070. <ref name="pmid15042359"/> | |||
==References== | ==References== | ||
Revision as of 13:30, 5 October 2012
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Hepatocellular carcinoma Microchapters |
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Differentiating Hepatocellular carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Hepatocellular carcinoma screening On the Web |
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American Roentgen Ray Society Images of Hepatocellular carcinoma screening |
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Risk calculators and risk factors for Hepatocellular carcinoma screening |
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Overview
"Surveillance is deemed cost-effective if the expected HCC risk exceeds 1.5% per year in patients with hepatitis C and 0.2% per year in patients with hepatitis B. Analysis of recent studies show that alpha-fetoprotein determination lacks adequate sensitivity and specificity for effective surveillance (and for diagnosis). Thus, surveillance has to be based on ultrasound examination. The recommended screening interval is 6 months" according to a clinical practice guideline by the American Association for the Study of Liver Diseases. [1]
"In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis" according to a systematic review by the NIHR Health Technology Assessment programme (UK). [2]
Evidence from trials
Regarding patients with hepatitis B, a meta-analysis by the Cochrane Collaboration concluded "".[3] In a randomized controlled trial included in the meta-analysis, the relative risk ratio of biannual alpha-fetoprotein and ultrasonography, as compared to no screening, for mortality from hepatocellular carcinoma was 0.6 and the relative risk reduction was 36.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality from hepatocellular carcinoma of 0.13% without treatment, the number needed to treat is 2070. [4]
References
- ↑
- ↑
- ↑ Aghoram R, Cai P, Dickinson JA (2012). "Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B." Cochrane Database Syst Rev. 9: CD002799. doi:10.1002/14651858.CD002799.pub2. PMID 22972059.
- ↑