Features | Partner Sites | Information | LinkXpress
Sign In
Schiller
VIEWORKS
TeraRecon

Hepatocellular Carcinoma Screening Linked with Curative Treatment and Longer Survival in Cirrhosis Patients

By Medimaging International staff writers
Posted on 24 Apr 2014
Image: Very high magnification micrograph of fibrolamellar hepatocellular carcinoma showing the characteristic laminated fibrosis between the tumor cells with a low N/C ratio. H&E stain (Photo courtesy of Wikimedia Commons).
Image: Very high magnification micrograph of fibrolamellar hepatocellular carcinoma showing the characteristic laminated fibrosis between the tumor cells with a low N/C ratio. H&E stain (Photo courtesy of Wikimedia Commons).
Investigators discovered that patients with cirrhosis who underwent surveillance (using liver ultrasound with or without measurement of serum alpha fetoprotein) for hepatocellular carcinoma (HCC) had cancers detected at an earlier stage, were more likely to receive curative instead of palliative treatment, and had longer survival.

In a systematic review and meta-analysis of 47 studies with 15,158 patients, Dr. Amit Singal, from the University of Texas Southwestern Medical Center (Dallas, USA) and colleagues reported that the pooled thee-year survival rate across all the studies was 50.8% among the 4,735 patients who underwent HCC surveillance, compared to 27.9% among the 6,115 patients without earlier surveillance (p < 0.001).

The finding of longer survival persisted after the authors limited their review to studies that took into account lead time bias. Lead time bias, as it applies to this study, is the time between when a disease would normally be diagnosed without screening and when the disease is diagnosed with screening. Detecting disease earlier through screening can at times seen be to increase survival when instead it only prolongs the time the person has the diagnosis. However, in this case, studies that accounted for lead time bias statistically still found that screening increased survival. Among the six studies that adjusted for lead time bias, those who underwent HCC surveillance had three-year survival rates of 39.7%, vs. 29.1% among those who did not (p < 0.001).

The authors noted that while screening for HCC in patients with Hepatitis B virus (HBV) infection is supported by a large randomized trial, no such randomized trials exist for patients with cirrhosis. Therefore the authors systematically reviewed published research that evaluated whether screening was associated with improved patient outcomes. While guidelines of the American Association for the Study of Liver Diseases and European Association for the Study of the Liver recommend monitoring with ultrasound every six months in high-risk patients (which includes those with chronic HBV infection and/or cirrhosis), the authors noted that studies have shown that surveillance in the United States is performed in less than 20% of these patients nationally, with lower rates among primary care physicians than gastroenterologists/hepatologists (physicians who specialize in caring for patients with liver disease).

A drawback of the study is that the studies were quite heterogeneous, suggesting benefits of surveillance may not be uniform among all patients, and studies did not include functional status, an important factor in determining appropriate treatment.

The authors concluded that, “the preponderance of data that consistently demonstrate benefits should provide sufficient rationale to recommend HCC surveillance, even in the absence of a randomized controlled trial among patients with cirrhosis.”

Related Links:

University of Texas Southwestern Medical Center



Channels

Radiography

view channel
Image: A 3x4 CMOS sensor array records the X-ray image (Photo courtesy of Alain Herzog /EPFL).

New X-Ray Diagnostic Imaging Equipment to Meet Needs of Developing Countries

The Ecole Polytechnique Fédérale de Lausanne (EPFL; Paris, France) has revealed a fully functional prototype of a high-tech, low-cost X-ray imaging device designed specifically for use in developing countries.... Read more

MRI

view channel
Image: High-definition MRI of water diffusion for studies of Traumatic Brain Injury (Photo courtesy of Sudhir Pathak & Walter Schneider/University of Pittsburgh).

Novel MRI Technique Can Help Diagnose Traumatic Brain Injuries

A new, advanced Magnetic Resonance Imaging (MRI) technique that can help detect subtle Traumatic Brain Injuries (TBI) has been developed by the US National Institute of Standards and Technology (NIST;... Read more

Nuclear medicine

view channel

PET/CT Dramatically More Effective at Diagnosing Heart Problems Than SPECT

Results of a study that compares the effectiveness of two heart imaging technologies, Single Photon Emission Computed Tomography (SPECT), and coronary-specific Positron Emission Tomography (cardiac PET/CT) have been presented at the 64th American College of Cardiology (ACC; Washington DC, USA) annual Scientific Session... Read more

General/Advanced Imaging

view channel
Image: Measuring the Magnetic Activity in the Brain of a Child, Using a MEG machine. (Photo courtesy of Children\'s Hospital of Philadelphia).

Study Suggests Language Delay Linked to Chromosome Deletion in Children with Neurological Disorders

A study found that children with neuro-developmental problems born with DNA duplications or deletions on part of chromosome 16, show measurable delays in their ability to process sound and language.... Read more

Imaging IT

view channel
Image: Schematic of the Virtual Multi-Site PACS (Photo courtesy of Carestream).

Shared Multisite Virtual PACS from Ten Individual PACS/RIS Systems Developed

The Cheshire and Merseyside districts in the UK have merged ten Picture Archiving and Communications Systems (PACS) and Radiology Information Systems (RIS) into one shared multi-site virtual PACS.... Read more

Industry News

view channel

Analysis of Worldwide CT Scanner Sector Released

A report by Kalorama Information (New York, NY, USA) analyzing the global Computed Tomography (CT) market has been published. The report surveyed the CT market outlook until 2018, and the drivers behind the changes. The report investigated CT market sizing, market forecast to 2018, analysis of trends, how the market... Read more
 
Copyright © 2000-2015 Globetech Media. All rights reserved.