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| {{Hepatocellular carcinoma}} | | {{Hepatocellular carcinoma}} |
| | | {{CMG}} {{AE}} {{MJK}} |
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| ==Overview== | | ==Overview== |
| | | According to the American Association of Liver Diseases recommendations, screening for hepatocellular carcinoma by ultrasound (US) is recommended among patients with [[hepatitis B]], [[hepatitis C]], and [[cirrhosis]]. Screening is also recommended for Asian men over the age of 40, Asian women over the age of 50, and African American. |
| "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">{{cite journal| author=Bruix J, Sherman M, American Association for the Study of Liver Diseases| title=Management of hepatocellular carcinoma: an update. | journal=Hepatology | year= 2011 | volume= 53 | issue= 3 | pages= 1020-2 | pmid=21374666 | doi=10.1002/hep.24199 | pmc=PMC3084991 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21374666 }} </ref>
| | ==Screening== |
| | | Screening for hepatocellular carcinoma by [[ultrasound]] recommended for the following: |
| "In a mixed-etiology 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">{{cite journal| author=Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M et al.| title=Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis. | journal=Health Technol Assess | year= 2007 | volume= 11 | issue= 34 | pages= 1-206 | pmid=17767898 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17767898 }} </ref>
| | *[[Hepatitis B]] |
| | | *[[Hepatitis C]] |
| ==Evidence from trials==
| | *[[Cirrhosis]] |
| 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">{{cite journal| author=Zhang BH, Yang BH, Tang ZY| title=Randomized controlled trial of screening for hepatocellular carcinoma. | journal=J Cancer Res Clin Oncol | year= 2004 | volume= 130 | issue= 7 | pages= 417-22 | pmid=15042359 | doi=10.1007/s00432-004-0552-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15042359 }} </ref>
| | *Asian men over the age of 40 |
| | | *Asian women over the age of 50 |
| | | *African American |
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |