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NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.
At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.
Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.
Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.
He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.
There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.
In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.
In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.
In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.
“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”
Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.
Disclosures: None of the researchers reported having relevant financial disclosures.
NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.
At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.
Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.
Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.
He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.
There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.
In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.
In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.
In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.
“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”
Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.
Disclosures: None of the researchers reported having relevant financial disclosures.
NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.
At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.
Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.
Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.
He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.
There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.
In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.
In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.
In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.
“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”
Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.
Disclosures: None of the researchers reported having relevant financial disclosures.