Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis.Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, Waljee A, Singal AG. Gastroenterology. 2018 Feb 6. [Epub ahead of print]

BACKGROUND & AIMS:Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis

METHODS: Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.RESULTS:Thirty-two studies (comprising 13367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% CI, 76%-92%), but early-stage HCC with only 47% sensitivity (95% CI, 33%-61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR], 0.88; 95% CI, 0.83-0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR, 0.81; 95% CI, 0.71-0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR, 1.08; 95% CI, 1.05-1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI, 48%-75%) and 45% sensitivity (95% CI, 30%-62%), respectively (P=.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI, 70%-92%).CONCLUSIONS:In a meta-analysis of publications, we found ultrasound alone to detect early-stage HCC with a low level of sensitivity in patients with cirrhosis. Addition of AFP to ultrasound analysis significantly increases the sensitivity of HCC detection in clinical practice.

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