Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2269-2286
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2269
Surveillance and diagnosis of hepatocellular carcinoma: A systematic review
Sonia Pascual, Cayetano Miralles, Juan M Bernabé, Javier Irurzun, Mariana Planells
Sonia Pascual, Cayetano Miralles, Liver Unit, Hospital General Universitario de Alicante, Alicante 03010, Spain
Sonia Pascual, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBEREHD, Alicante 03010, Spain
Juan M Bernabé, Javier Irurzun, Mariana Planells, Radiology Department, Hospital General Universitario de Alicante, Alicante 03010, Spain
Author contributions: Pascual S, Miralles C, Bernabé JM, Irurzun J, and Planells M contributed equally to the work; Pascual S conceptualized and designed the review and drafted the initial manuscript; All authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: No conflict of interest to declare.
PRISMA 2009 Checklist statement: This systematic review was conducted according to the PRISMA guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sonia Pascual, MD, Staff Physician, Liver Unit, Hospital General Universitario de Alicante, HGU Alicante, C/ Pintor Baeza 11, Alicante 03010, Spain. pascual_son@gva.es
Telephone: +34-96-5933468 Fax: +34-96-5933469
Received: March 26, 2019
Peer-review started: March 26, 2019
First decision: May 24, 2019
Revised: July 4, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: August 26, 2019
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) appears in most of cases in patients with advanced liver disease and is currently the primary cause of death in this population. Surveillance of HCC has been proposed and recommended in clinical guidelines to obtain earlier diagnosis, but it is still controversial and is not accepted worldwide.

AIM

To review the actual evidence to support the surveillance programs in patients with cirrhosis as well as the diagnosis procedure.

METHODS

Systematic review of recent literature of surveillance (tools, interval, cost-benefit, target population) and the role of imaging diagnosis (radiological non-invasive diagnosis, optimal modality and agents) of HCC.

RESULTS

The benefits of surveillance of HCC, mainly with ultrasonography, have been assessed in several prospective and retrospective analysis, although the percentage of patients diagnosed in surveillance programs is still low. Surveillance of HCC permits diagnosis in early stages allows better access to curative treatment and increases life expectancy in patients with cirrhosis. HCC is a tumor with special radiological characteristics in computed tomography and magnetic resonance imaging, which allows highly accurate diagnosis without routine biopsy confirmation. The actual recommendation is to perform biopsy only in indeterminate nodules.

CONCLUSION

The evidence supports the recommendation of performing surveillance of HCC in patients with cirrhosis susceptible of treatment, using ultrasonography every 6 mo. The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis.

Keywords: Surveillance, Hepatocellular carcinoma, Ultrasonography, Cirrhosis, Imaging diagnosis

Core tip: Hepatocellular carcinoma is one of the tumors with the worst prognosis and the 5-year survival is discouraging. The advantages of surveillance of hepatocellular carcinoma in patients with cirrhosis remains controversial, but the best strategy considered is to diagnose the tumor in early stage, which gives the opportunity to access better curative treatment. The current review will focus on the more recent available evidence about surveillance and diagnosis of hepatocellular carcinoma.