Hepatocellular carcinoma screening
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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-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 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
- ↑ Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011). "Management of hepatocellular carcinoma: an update". Hepatology. 53 (3): 1020–2. doi:10.1002/hep.24199. PMC 3084991. PMID 21374666.
- ↑ Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M; et al. (2007). "Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis". Health Technol Assess. 11 (34): 1–206. PMID 17767898.
- ↑ 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.
- ↑ Zhang BH, Yang BH, Tang ZY (2004). "Randomized controlled trial of screening for hepatocellular carcinoma". J Cancer Res Clin Oncol. 130 (7): 417–22. doi:10.1007/s00432-004-0552-0. PMID 15042359.