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Liver Transpl. 2019 Mar;25(3):369-379. doi: 10.1002/lt.25398.

Frequency and Outcomes of Abnormal Imaging in Patients With Cirrhosis Enrolled in a Hepatocellular Carcinoma Surveillance Program.

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Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.


There are limited data on the downstream effects of hepatocellular carcinoma (HCC) surveillance, including the frequency of false-positive results. We aimed to quantify the incidence of indeterminate nodules (INs) and the follow-up testing needed to resolve these findings among patients enrolled in a structured HCC surveillance program. We retrospectively analyzed adult patients with cirrhosis enrolled in a structured HCC surveillance program in a large tertiary care center. Outcomes included surveillance benefits, defined as early HCC detection, and harm, defined as INs prompting additional diagnostic evaluation. Among 999 patients followed for a median of 2.2 years, HCC surveillance imaging was consistently completed every 6, 9, and 12 months in 46%, 51%, and 68% of patients, respectively. Of 256 (25.6%) patients with abnormal imaging, 69 (27.0%) were diagnosed with HCC and 187 (73.0%) with INs. Most HCC (n = 54, 78.3%) were found within Milan criteria. Among those with an IN, 78.1% returned to ultrasound surveillance after a median of 2 (interquartile range [IQR], 1-3) negative computed tomography (CT)/magnetic resonance imaging (MRI) scans, and 21.9% continued CT/MRI imaging (median, 1; IQR, 1-2). Eleven patients underwent diagnostic liver biopsy. Hypoalbuminemia, thrombocytopenia, and larger nodule size were independently associated with HCC diagnosis. In conclusion, 1 in 4 patients enrolled in an HCC surveillance program had abnormal surveillance imaging, but three-fourths of the lesions were INs, resulting in downstream harm. Improved risk-stratification tools are needed to identify nodules that are benign to reduce follow-up diagnostic evaluation.

[Available on 2020-03-01]

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