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Alimentary Pharmacology & Therapeutics
Volume 30 Issue 1, Pages 37 - 47
Published Online: 8 Apr 2009
2006 The Authors Journal compilation 2006 Blackwell Publishing Ltd

Meta-analysis: surveillance with ultrasound for early-stage hepatocellular
carcinoma in patients with cirrhosis

A. SINGAL*, M. L. VOLK*, A. WALJEE*, R. SALGIA*, P. HIGGINS*, M. A. M. ROGERS†
& J. A. MARRERO*
*Division of Gastroenterology and †Division of General Medicine, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Correspondence to Dr J. A. Marrero, Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, 3912 Taubman Center, SPC 5362, Ann
Arbor, MI 48109, USA.
E-mail: jmarrero@umich. edu
Copyright Journal compilation © 2009 Blackwell Publishing Ltd

ABSTRACT
Background A majority of studies investigating the accuracy of ultrasound for
detecting hepatocellular carcinoma (HCC) do not reflect how this test is used
for surveillance vs. diagnosis.

Aim To determine the performance characteristics of surveillance with ultrasound
for the detection of HCC, particularly early HCC as defined by the Milan
criteria.

Methods A systematic literature review using the

MEDLINE and SCOPUS databases yielded six studies that evaluated the accuracy of
ultrasound for HCC at any stage and 13 studies that were specific to early HCC.

Results Surveillance ultrasound detected the majority of tumours before they
presented clinically, with a pooled sensitivity of 94%. However, ultrasound was
less effective for detecting early HCC with a sensitivity of 63%.
Alpha-fetoprotein provided no additional benefit to ultrasound. Meta-regression
analysis demonstrated a significantly higher sensitivity for early HCC with
ultrasound every 6 months than with annual surveillance. Current studies have
limitations such as verification bias and are of suboptimal quality.

Conclusions Surveillance with ultrasound demonstrates limited sensitivity for
early HCC, although this may be improved by testing at 6-month intervals.
Currently available evidence evaluating surveillance ultrasound has significant
limitations and future studies are necessary to determine optimal surveillance
methods for early HCC.

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Publication data Submitted 8 January 2009 First decision 30 January 2009
Resubmitted 16 February 2009 Resubmitted 1 April 2009 Accepted 2 April 2009 Epub
Accepted Article 8 April 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1365- 2036.2009. 04014


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