Affiliation:
1. Division of Gastroenterology Veterans Affairs Puget Sound Healthcare System and University of Washington Seattle Washington USA
2. Liver Imaging Group, Department of Radiology University of California at San Diego La Jolla California USA
3. NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine University of California at San Diego La Jolla California USA
Abstract
SummaryBackgroundHepatocellular carcinoma (HCC) incidence and mortality continue to rise worldwide. Society guidelines recommend HCC screening for patients with chronic hepatitis B (CHB) or cirrhosis. Unfortunately, HCC screening rates remain relatively low, and the performance characteristics of current screening modalities are suboptimal.AimThe aim of the study was to discuss the current state of HCC screening and imaging diagnosis utilising standard and emerging imaging modalities in addition to outlining areas of need and ongoing study.MethodsA review of the field was performed combining literature searches and expert opinion.ResultsThe development of the Liver Imaging Reporting and Data System (LI‐RADS version 2018) algorithms have advanced and standardised the imaging diagnosis of HCC. While guidelines recommend US for HCC screening, the sensitivity of ultrasound is highly variable for the detection of early‐stage HCC with sensitivity reports ranging from 40% to 80%. Biomarker‐based scores such as GALAD and alternative imaging modalities such as abbreviated MRI are promising tools to improve HCC early detection. Patients with non‐alcoholic fatty liver disease (NAFLD) and patients hepatitis C (HCV) who have achieved sustained virologic response (SVR) can present a clinical dilemma regarding the need for HCC screening. Biomarkers and elastography can aid in identification of individuals at high risk for HCC in these populations.ConclusionsThe LI‐RADS system has standardised the imaging interpretation and diagnosis of HCC. Work remains regarding screening in special populations and optimization of screening modalities.
Funder
National Institute of Environmental Health Sciences
National Center for Advancing Translational Sciences
National Institute of Diabetes and Digestive and Kidney Diseases
National Heart, Lung, and Blood Institute
National Institute on Alcohol Abuse and Alcoholism
Subject
Pharmacology (medical),Gastroenterology,Hepatology
Reference56 articles.
1. Global Epidemiology, Prevention, and Management of Hepatocellular Carcinoma
2. American Cancer Society.Cancer Facts & Figures 2021. Atlanta GA.2021[2002 February 23]. Available from:https://www.cancer.org/content/dam/cancer‐org/research/cancer‐facts‐and‐statistics/annual‐cancer‐facts‐and‐figures/2021/cancer‐facts‐and‐figures‐2021.pdf
3. Incidence of hepatocellular carcinoma in children in Khon Kaen before and after national hepatitis B vaccine program;Wichajarn K;Asian Pac J Cancer Prev,2008
4. Hepatocellular Carcinoma
5. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study