Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma.
BACKGROUND & AIMS
Although contrast-enhanced computed tomography (CT), dynamic magnetic resonance (MRI) and fine needle biopsy (FNB) are the standard of care to diagnose hepatocellular carcinoma (HCC), the clinical and economic benefits of the updated AASLD diagnostic algorithm, including the drop of contrast enhanced ultrasound (CEUS), have not been previously evaluated.


METHODS
119 de novo liver nodules detected during ultrasound (US) surveillance in 98 cirrhotics, 7 <1cm, 67 1-2cm, 45 >2cm in size, were sequentially examined by CEUS and CT, using MRI as a rescue approach in patients lacking a typical vascular pattern for HCC by one or both contrast techniques in the 1-2cm nodules and by CT in the >2cm nodules. A FNB was performed when required to meet both 2005 and 2010 AASLD criteria.


RESULTS
Eighty-four (70%) nodules were HCC: the radiological diagnosis was done in 38 (88%) of those 1-2cm and in 38 (95%) for those >2cm HCCs according to 2010 AASLD criteria. CT or MRI detected 13 HCC nodules that were missed by unenhanced US. Despite an absolute specificity, CEUS failed to identify any HCC uncharacterized by CT or MRI. By updated AASLD criteria, 6 (17%) FNB procedures were spared in patients with 1-2cm nodules (p=0.025), as compared to 2005 criteria. The 2010 vs. 2005 AASLD per patient cost was similar in 1-2cm nodules, 432 € vs. 451 € (p=0.46), but lower in >2cm nodules, 248 € vs. 321 € (p<0.001).


CONCLUSIONS
A sequential study with either CT or MRI enhances the radiological diagnosis of HCC and reduces costs and liver biopsy need.
['Manini|Matteo Angelo|MA|', 'Sangiovanni|Angelo|A|', 'Fornari|Fabio|F|', 'Piscaglia|Fabio|F|', 'Biolato|Marco|M|', 'Fanigliulo|Libera|L|', 'Ravaldi|Elisa|E|', 'Grieco|Antonio|A|', 'Colombo|Massimo|M|', '|||']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000465:Algorithms D044963:Biopsy, Fine-Needle D006528:Carcinoma, Hepatocellular D003287:Contrast Media D003365:Costs and Cost Analysis D003951:Diagnostic Errors D005260:Female D006801:Humans D008103:Liver Cirrhosis D008113:Liver Neoplasms D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D017410:Practice Guidelines as Topic D011446:Prospective Studies D012955:Societies, Medical D014057:Tomography, X-Ray Computed D014463:Ultrasonography D014481:United States
Hepatocellular carcinoma Surveillance Cirrhosis Clinical guidelines Imaging techniques