title: Hepatocellular carcinoma surveillance: a national survey of current practices in the USA.
abstract: BACKGROUND
  The incidence rate of hepatocellular carcinoma (HCC) in the USA is rapidly rising. Surveillance using biannual ultrasound (US) is recommended, but actual practices are unknown.
  
  
  OBJECTIVE
  To determine current HCC surveillance practices among gastroenterology and hepatology providers in the USA.
  
  
  METHODS
  A 21-question electronic survey was emailed to 12,485 gastroenterology and hepatology providers in the USA. The survey contained questions concerning provider background, surveillance practices, and opinions. Pearson chi-square and multivariate logistic regression tests were used to analyze the data.
  
  
  RESULTS
  We received 777 responses (6.2% response rate); 656 were eligible for analysis. 92% place cirrhotic patients under surveillance independent of etiology, 79% exclusively use a 6-month interval, and 77% use alpha-fetoprotein. While 93% use US, only 36% use US exclusively and 60% use two or more imaging modalities. Providers from transplant centers favor using additional imaging modalities, instead of only US. Multivariate analysis showed transplant center providers who allocate more time to patient care (OR 1.96, p = 0.004) and see more cirrhotic patients (OR 2.07, p = 0.033) have increased odds of using additional imaging modalities.
  
  
  CONCLUSIONS
  Participating providers reported very high rates of surveillance utilization and use of a biannual interval. It is likely that the sample is composed of providers who are very engaged and informed about HCC surveillance. However, their surveillance imaging practices largely deviated from practice guidelines, which all recommend only using US. Providers affiliated with transplant centers tend to use additional imaging modalities such as computed tomography and MRI, instead of US only.
authors.affiliation: UCSD Medical Center, 200 West Arbor Drive # 8413, San Diego, CA, 92103, USA, Kjoshi0@alumni.ucsd.edu.
authors.forename: Kartik
authors.initials: K
authors.lastname: Joshi
authors.forename: Michel
authors.initials: M
authors.lastname: Mendler
authors.forename: Robert
authors.initials: R
authors.lastname: Gish
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuo
authors.forename: Heather
authors.initials: H
authors.lastname: Patton
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kono
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D003625:Data Collection; D006801:Humans; D015994:Incidence; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000453:epidemiology*; D015999:Multivariate Analysis; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology