Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma.
OBJECTIVE
Although contrast-enhanced computed tomography (CT), dynamic magnetic resonance (MRI) and fine needle biopsy (FNB) are the standard of care to diagnose hepatocellular carcinoma (HCC), the clinical and economic benefits of the updated AASLD diagnostic algorithm, including the drop of contrast enhanced ultrasound (CEUS), have not been previously evaluated.


METHODS
119 de novo liver nodules detected during ultrasound (US) surveillance in 98 cirrhotics, 7 <1cm, 67 1-2cm, 45 >2cm in size, were sequentially examined by CEUS and CT, using MRI as a rescue approach in patients lacking a typical vascular pattern for HCC by one or both contrast techniques in the 1-2cm nodules and by CT in the >2cm nodules. A FNB was performed when required to meet both 2005 and 2010 AASLD criteria.


RESULTS
Eighty-four (70%) nodules were HCC: the radiological diagnosis was done in 38 (88%) of those 1-2cm and in 38 (95%) for those >2cm HCCs according to 2010 AASLD criteria. CT or MRI detected 13 HCC nodules that were missed by unenhanced US. Despite an absolute specificity, CEUS failed to identify any HCC uncharacterized by CT or MRI. By updated AASLD criteria, 6 (17%) FNB procedures were spared in patients with 1-2cm nodules (p=0.025), as compared to 2005 criteria. The 2010 vs. 2005 AASLD per patient cost was similar in 1-2cm nodules, 432 € vs. 451 € (p=0.46), but lower in >2cm nodules, 248 € vs. 321 € (p<0.001).


CONCLUSIONS
A sequential study with either CT or MRI enhances the radiological diagnosis of HCC and reduces costs and liver biopsy need.
A.M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Matteo Angelo
MA
Manini
A.M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. Electronic address: angelo.sangiovanni@policlinico.mi.it.
Angelo
A
Sangiovanni
Gastroenterology and Hepatology Unit, "G. da Saliceto" Hospital, Piacenza, Italy.
Fabio
F
Fornari
Division of Internal Medicine, "Sant'Orsola Malpighi" Hospital, University of Bologna, Italy.
Fabio
F
Piscaglia
Institute of Internal Medicine, School of Medical, Catholic University of the Sacred Heart, Rome, Italy.
Marco
M
Biolato
Gastroenterology and Hepatology Unit, "G. da Saliceto" Hospital, Piacenza, Italy.
Libera
L
Fanigliulo
Division of Internal Medicine, "Sant'Orsola Malpighi" Hospital, University of Bologna, Italy.
Elisa
E
Ravaldi
Institute of Internal Medicine, School of Medical, Catholic University of the Sacred Heart, Rome, Italy.
Antonio
A
Grieco
A.M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Massimo
M
Colombo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000191:economics; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D003287:Contrast Media; D003365:Costs and Cost Analysis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012955:Societies, Medical; D014057:Tomography, X-Ray Computed / Q000191:economics; D014463:Ultrasonography / Q000191:economics; D014481:United States
D003287:Contrast Media
Cirrhosis; Clinical guidelines; Hepatocellular carcinoma; Imaging techniques; Surveillance