Clinical

Ultrasound plus AFP can replace CT/MRI screening for liver cancer

Last Updated: 2010-05-03 19:48:22 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Patients with cirrhosis can be screened for hepatocellular carcinoma (HCC) with ultrasound imaging plus alfa fetoprotein (AFP) levels, instead of more expensive imaging studies, according to data presented Sunday at Digestive Disease Week 2010 in New Orleans.

Many radiologists say the high degree of echogenicity of cirrhotic livers makes it difficult or impossible to rule out HCC with ultrasonography, so these patients should also have computed tomography (CT) or magnetic resonance imaging (MRI) studies, senior investigator Dr. Roger D. Soloway said at a press conference.

"We have been increasingly uncomfortable with that, because those imaging techniques are so much more expensive," he added.

He and his colleagues at the University of Texas Medical Branch at Galveston followed 160 patients with cirrhosis who had screening ultrasound exams followed by CT or MRI within 6 months. Thirty-four patients had HCC.

Ultrasonography alone correctly identified 26 of the cancers, with one false positive, yielding a specificity of 99.2% and sensitivity of 76.5%. Six of the 8 patients whose cancers were missed by ultrasonography had AFP levels above 20 ng/mL. The two tests in combination had a sensitivity of 87.5%.

Among 125 patients with a true negative ultrasound, the mean AFP level was 17.14 ng/mL, with only 12 patients having an AFP above 20 ng/mL.

In their abstract, the investigators note that 74 CT or MRI studies in this series could have been avoided with a combination of ultrasound and AFP.

"We feel that we can strongly recommend that ultrasound and AFP be the initial screening test and thus decrease the cost of screening, which as you can see at 6 months intervals would be considerable over the lifetime of the patient," Dr. Soloway said.

Dr. Frank Anania from Emory University moderated the press conference. "At the present time there is no agreement on screening for HCC," he said. "As far as I know, there has been no large study yet showing CT or MRI to be superior to ultrasound in changing morbidity and mortality" in patients with cirrhosis.

"This is part of the ongoing work in determining cost effective measures for screening populations effectively," he said.