title: Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis.
abstract: OBJECTIVE
  Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance.
  
  
  METHODS
  We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm).
  
  
  RESULTS
  HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P < .01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC.
  
  
  CONCLUSIONS
  Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months.
authors.affiliation: Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy. Electronic address: paolo.delpoggio@fastwebnet.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.affiliation: Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Olmi
authors.affiliation: Unità di Epatologia, Policlinico S. Marco, Zingonia, Bergamo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Di Marco
authors.affiliation: Medicina Interna e Gastroenterologia, Università Cattolica, Rome, Italy.
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.affiliation: Medicina Interna ed Epatologia, Ospedale Fatebenefratelli, Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Dipartimento di Scienze Mediche e Chirugiche, Medicina Interna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Gastroenterologia, Università di Genova, Genova, Italy.
authors.forename: Edoardo Giovanni
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Gastroenterologia, Ospedale Negrar, Verona, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.affiliation: Dipartimento di Scienze Mediche e Chirugiche, Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Early Detection; Fibrosis; Liver Cancer; Survival