title: Community-based mass ultrasonographic screening of hepatocellular carcinoma among thrombocytopenic adults.
abstract: Thrombocytopenia has been reported as a valid surrogate for liver cirrhosis and could be used to identify groups at high risk of hepatocellular carcinoma (HCC) for ultrasonographic (US) screening. We designed this two-stage community-based screening for HCC. In 2004, subjects (ages > or =40 years) were invited to undergo comprehensive health examinations, with 17,551 men (ages 63.0 +/- 11.5 years) and 39,151 women (ages 59.9 +/- 11.7 years) participating. Subjects with platelet counts <150 x 10(9)/L or alpha-fetoprotein (AFP) >20 ng/mL were enrolled for the second-stage US screening; 3,242 subjects (5.7%; male/female, 1,415/1,827; age 66 +/- 10 years) were candidates for US screening and 2,983 (92.2%) responded. Of 137 suspected cases, 124 (90.5%) complied with referral for confirmation and 72 (58.1%) were confirmed to be HCC cases (male/female, 41/31; age 68.1 +/- 8.8 years). Screening with AFP, thrombocytopenia, or both could identify 0.64% (n = 364), 5.33% (n = 3,205), and 5.7% (n = 3,242) of the high-risk subjects from the population, estimated to include 50.5%, 54.5%, and 71.3% of all HCC cases. Among confirmed patients, tumor diameters were <3 cm for the 27 (37.5%) patients and 3 to 5 cm for the 23 (31.9%) patients. Only 5 (6.9%) patients' conditions were too advanced to be actively treated. This study enrolled only 5.7% of the participants for US, which cover 64.7% to 71.3% of the HCC cases. Most (93%) of the detected cases were caught early enough to undergo effective treatment modalities. This HCC screening protocol should be feasible, economical, and effective.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC. juten@ms17.hinet.net
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Pao-Fei
authors.initials: PF
authors.lastname: Chen
authors.forename: Hung-Da
authors.initials: HD
authors.lastname: Tung
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Tseng
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Kwong-Ming
authors.initials: KM
authors.lastname: Kee
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Chang
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Yao-Der
authors.initials: YD
authors.lastname: Chen
authors.forename: Lin-San
authors.initials: LS
authors.lastname: Tsai
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D013921:Thrombocytopenia / Q000150:complications* / Q000453:epidemiology; D014463:Ultrasonography