Factors That Affect Efficacy of Ultrasound Surveillance for Early Stage Hepatocellular Carcinoma in Patients With Cirrhosis

Paolo Del Poggio, Stefano Olmi, Francesca Ciccarese, Mariella Di Marco, Gian Ludovico Rapaccini, Luisa Benvegnù, Franco Borzio, Fabio Farinati, Marco Zoli, Edoardo Giovanni Giannini, Eugenio Caturelli, Maria Chiaramonte, Franco Trevisani, Mauro Bernardi, Maurizio Biselli, Paolo Caraceni, Alessandro Cucchetti, Marco Domenicali, Marta Frigerio, Annagiulia GramenziFrancesca Garuti, Barbara Lenzi, Donatella Magalotti, Matteo Ravaioli, Anna Giacomin, Veronica Vanin, Caterina Pozzan, Gemma Maddalo, Alfredo Alberti, Angelo Gatta, Maurizio Gios, Alberta Cappelli, Emanuela Giampalma, Rita Golfieri, Cristina Mosconi, Matteo Renzulli, Paola Roselli, Serena Dell'Isola, Anna Maria Ialungo, Domenico Risso, Giorgio Sammito, Simona Marenco, Linda Bruzzone, Giulia Bosco

Research output: Contribution to journalArticlepeer-review


Background & Aims: Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance. Methods: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm). Results: HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P <.01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC. Conclusions: Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months.

Original languageEnglish
Pages (from-to)1927-1933
Number of pages7
JournalClinical Gastroenterology and Hepatology
Issue number11
Publication statusPublished - Nov 1 2014


  • Early Detection
  • Fibrosis
  • Liver Cancer
  • Survival

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


Dive into the research topics of 'Factors That Affect Efficacy of Ultrasound Surveillance for Early Stage Hepatocellular Carcinoma in Patients With Cirrhosis'. Together they form a unique fingerprint.

Cite this