SONOGRAPHIC SCREENING FOR HEPATOCELLULAR-CARCINOMA IN PATIENTS WITH CHRONIC HEPATITIS OR CIRRHOSIS - AN EVALUATION

OBJECTIVE. The purposes of this study were to determine the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis o r cirrhosis and to assess the cost and benefit of sonographic screenin g for HCC. MATERIALS AND METHODS. We reviewed 647 sonograms of 232 pat ients obtained over an 8-year period. One hundred fifty-two patients h ad at least two sonograms. One hundred fifty-four men and 78 women wit h a mean age of 51 years were included. Most patients (n = 207) had bi opsy-proven cirrhosis. Ethnicity, age, gender, type of liver disease, and cc-fetoprotein levels were analyzed to determine factors associate d with HCC detection. The costs of sonography and other tests were cal culated using the Australian government Medicare benefits schedule.RES ULTS. Thirty-one patients (13%) had elevated a-fetoprotein levels. Liv er masses were found in 25 (11%) patients. Six (2.6%) patients had HCC on biopsy (n = 3) or other tests. All cases of HCC were inoperable be cause of tumor multicentricity or metastases (n = 2) or both, or becau se of the relatively large size or poor physical condition of the pati ent (n = 4) or both. The only variable associated with detection of HC C was alcohol-related liver disease (p =.01). Of the six patients with HCC, one had an elevated a-fetoprotein level. The yearly incidence of HCC was 1.4%. Other masses shown by sonography included regenerating nodules (n = 5), he mangiomas (n = 5), focal fat sparing (n = 4), meta stases (n = 2), and other lesions tit = 3). No patient underwent surgi cal resection, which precluded calculation of a survival benefit. The cost of our screening program was $8472 (United States dollars) per HC C. CONCLUSION. Sonographic screening is superior to cc-fetoprotein ass ay for detection of HCC, but in this study, screening did not decrease mortality.