title: Ultrasound surveillance for hepatocellular carcinoma: service evaluation of a radiology-led recall system in a tertiary-referral centre for liver diseases in the UK.
abstract: OBJECTIVE
  To review the radiology-led ultrasound (US) surveillance programme for the detection of hepatocellular carcinoma (HCC) in cirrhotic patients in a UK tertiary-referral centre.
  
  
  METHODS
  The radiology information system was searched for patients who had undergone US for surveillance of cirrhosis from September 2009 to May 2013. Patient demographics and cirrhosis aetiology were documented. Data including numbers of surveillance scans, abnormal findings suspicious for HCC, subsequent radiological investigations, numbers of HCC and survival for HCC patients were recorded. Service performance data, such as rates of attendance and rebooking, were also recorded.
  
  
  RESULTS
  Eight hundred and four patients entered surveillance and 2,366 surveillance US examinations were performed; 368 (46%) underwent follow-up (6-monthly US). Abnormalities leading to further radiological investigations were found in 81 patients. Reasons for incomplete surveillance included non-attendance and radiology failure to re-book appointments. HCC was diagnosed in 22 patients. Fourteen had HCC diagnosed on a surveillance scan, eight had HCC diagnosed on a scan performed for other reasons. Patients diagnosed with HCC on a surveillance scan were more likely to be treated with curative intent and had longer survival.
  
  
  CONCLUSIONS
  Even with a radiology-led recall service for HCC surveillance, the proportion of patients receiving scans 6-monthly was low, due in part to the lack of organisational support that is available for other screening programmes. This study gives a realistic representation of the implementation of surveillance in a UK hospital at the current time and of the rates of HCC proceeding to treatment.
authors.affiliation: Department of Radiology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK. Electronic address: catfarrell1@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Farrell
authors.affiliation: Department of Radiology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Halpen
authors.affiliation: Department of Gastroenterology and Hepatology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: T J S
authors.initials: TJ
authors.lastname: Cross
authors.affiliation: Department of Gastroenterology and Hepatology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Richardson
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, The Duncan Building, Daulby Street, University of Liverpool, Liverpool L69 3GA, UK.
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Department of Radiology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: E C
authors.initials: EC
authors.lastname: Joekes
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011873:Radiology Information Systems; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014463:Ultrasonography; D006113:United Kingdom / Q000453:epidemiology