Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation

OBJECTIVE: Recognition of hepatocellular carcinoma (HCC) is important in th e management of patients awaiting liver transplantation. HCCs >5 cm in diam eter 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 pretranspl ant screening program. METHODS: The study is a retrospective analysis 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) testin g within 6 months of transplantation. Radiographic reports were subdivided into low-risk and high-risk groups, based upon level of suspicion for HCC. The results were compared to explant pathology. RESULTS: Pathological analysis of 106 explants revealed HCC in 19 patients. High-risk US exams had a positive predictive value (PPV) of 0.69 and a neg ative predictive value (NPV) of 0.91 in the diagnosis of HCC. High-risk CT exams 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 h igh-risk CT and low-risk US. Four patients, all with HCC <4 cm, had low-ris k US, CT, and serum AFP. CONCLUSIONS: US, CT, and serum AFP, as single tests, are insensitive for de tection of HCC in the cirrhotic liver. However, they are highly specific. S ensitivity 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 patient s with end-stage liver disease undergoing liver trans plantation. (Am J Gas troenterol 2000;95:1535-1538. (C) 2000 by Am. Cell. of Gastroenterology).