Am J Gastroenterol 2000 Jun;95(6):1535-8
Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation
Gambarin-Gelwan M, Wolf DC, Shapiro R, Schwartz ME, Min AD Department of Medicine, Mount Sinai Medical Center, New York, New York, USA.
Objective: Recognition of hepatocellular carcinoma (HCC) is important in the management of patients awaiting liver transplantation. HCCs >5 cm in diameter are at high risk to recur after transplant. The goal of this study was to assess the sensitivity of the diagnostic tests employed in a pretransplant screening program.
Methods: The study is a retrospectiveanalysis of charts of 106 consecutive adults transplanted over a 1-yr period. All patients had ultrasonography (US),computerized tomography (CT), and serum alpha fetoprotein (AFP) testing within 6 months of transplantation. Radiographicreports were subdivided into low-risk and high-risk groups, based upon level of suspicion for HCC. The results were comparedto explant pathology.
Results: Pathological analysis of 106 explants revealed HCC in 19 patients. High-risk US exams had apositive predictive value (PPV) of 0.69 and a negative predictive value (NPV) of 0.91 in the diagnosis of HCC. High-risk CTexams had a PPV of 0.67 and an NPV of 0.90. When patients had either a high-risk US or a high-risk CT, there was a PPV of 0.59 and an NPV of 0.83. Of the 19 patients with HCC, three had high-risk US and low-risk CT; two had high-risk CT and low-risk US. Four patients, all with HCC <4 cm, had low-risk US, CT, and serum AFP.
Conclusions: US, CT, and serum AFP, as single tests, are insensitive for detection of HCC in the cirrhotic liver. However, they are highly specific. Sensitivity and specificity for US are comparable to those for CT. Given its lower cost, US is preferable to CT for routine screening of HCC in patients with end-stage liver disease undergoing liver transplantation.
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