Ultrasound Surveillance for Hepatocellular Carcinoma
of At-Risk Patients in Ramathibodi Hospital
Duangkamon Prapruttam MD*, Jitkasem Suksai MD*,
Taya Kitiyakara MD**, Sith Phongkitkarun MD*
Affiliation :
* Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
** Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
Background : Surveillance for hepatocellular carcinoma (HCC) is recommended for patients at risk of developing HCC.
However, the pattern of surveillance in clinical practice is unclear.
Objective : To assess the adherence of surveillance program in the detection of HCC and to determine the prevalence of
HCC in the at-risk patients who were on surveillance in Ramathibodi Hospital.
Material and Method: Retrospective descriptive study of at-risk patients, who were followed in the liver clinic at Ramathibodi
Hospital between January 1, 2007 and December 31, 2012. Clinical data were collected from electronic medical records
and radiologic data were extracted from the radiology database (PACS). The US findings of focal liver lesion were analyzed
for number, size, location, and echogenicity. When focal liver lesions suggestive of HCC were detected on ultrasonography,
dynamic contrast enhanced CT or MRI was used to diagnose HCC. On CT/MRI, focal lesions were considered to be HCC
when hypervascularity in the arterial phase and washout in the portal venous or delayed phase was found.
Results : Nine hundred seven patients with risk(s) for HCC underwent ultrasound surveillance. The mean number of
ultrasound examinations per patient was 4.72.2 scans during the course of follow-up. The mean total adherence time was
37.017.1 months. The median time interval between each ultrasound examination was 8.4 months (range: 1.1-63.0 months).
Focal liver lesions were detected in 161 of 907 patients (17.8%). No new focal liver lesion was detected at less than 3-month
interval. The majority of patients were evaluated further by MRI (n = 99; 62.3%) or by CT scan (n = 33; 20.8%). The period
prevalence of HCC in patients who received US surveillance was 3.5% (32 patients in 907 patients). Most of patients with
HCC were male (71.9%) and the major risk factor was chronic hepatitis B (50.0%). Twenty-one of 32 patients (65.6%) had
normal serum AFP levels. Most HCC’s (75.0%) were detected at 8-month interval. The cumulative percentage of HCC’s
detected at 6-month and 12-month surveillance intervals were 11.1% and 70.4%, respectively. The median tumor size was
22.5 mm, ranging from 12-134 mm. At the time of HCC diagnosis, eight patients (25.0%) had HCC within BCLC very early
stage (by size criteria) and 19 patients (59.4%) were in BCLC early stage.
Conclusion : Although there were irregular surveillance intervals in our clinical practice, the overall adherence of patients
to surveillance was acceptable, with the period prevalence of HCC 3.5% and the majority discovered in the early stage.
Keywords : Hepatocellular carcinoma (HCC), Surveillance, Ultrasonography (US)
All Articles
Download