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
ARTICLE HIGHLIGHTS
Research background

Surveillance of hepatocellular carcinoma (HCC) has been proposed and recommended in clinical guidelines, in order to obtain earlier diagnosis but it is still controversial and it is not accepted worldwide.

Research motivation

Emerging populations like non-alcoholic fatty liver disease patients or hepatitis C virus (HCV) after achieving sustained viral response (SVR) are at risk of developing HCC. Should they be screened? What is the ideal screening tool attending cost-effectiveness?

Research objectives

Support the surveillance programs in patients at risk of developing HCC because of the cost-effectiveness of early diagnosis.

Research 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.

Research results

The benefits of surveillance of HCC, mainly with ultrasonography, have been assessed in several prospective and retrospective analysis. Surveillance of HCC permits diagnosis in early stages allowing better access to curative treatment and increased life expectancy in patients at risk.

Research conclusions

The actual evidence supports the recommendation of performing surveillance of HCC in patients with cirrhosis or advanced fibrosis of any etiology susceptible of treatment, using ultrasonography every 6 mo. In some populations of non-cirrhotic hepatitis B virus patients the screening can be cost-effective. The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis.

Research perspectives

Further studies need for evaluating the cost-effectiveness of screening in emerging populations like non-cirrhotic non-alcoholic fatty liver disease patients or HCV who achieved SVR. Utility of hepatospecific contrasts needs further evaluation.