Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

Kristina Tzartzeva, Joseph Obi, Nicole E. Rich, Neehar D. Parikh, Jorge A. Marrero, Adam Yopp, Akbar K. Waljee, Amit G. Singal

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background & Aims: Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis. Methods: Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Results: Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P =.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%–92%). Conclusions: We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.

Original languageEnglish (US)
Pages (from-to)1706-1718.e1
JournalGastroenterology
Volume154
Issue number6
DOIs
StatePublished - May 1 2018

Fingerprint

alpha-Fetoproteins
Meta-Analysis
Hepatocellular Carcinoma
Fibrosis
Confidence Intervals
Guidelines
MEDLINE
Magnetic Resonance Spectroscopy
Tomography

Keywords

  • Alpha Fetoprotein
  • Liver Cancer
  • Screening
  • Ultrasound

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis : A Meta-analysis. / Tzartzeva, Kristina; Obi, Joseph; Rich, Nicole E.; Parikh, Neehar D.; Marrero, Jorge A.; Yopp, Adam; Waljee, Akbar K.; Singal, Amit G.

In: Gastroenterology, Vol. 154, No. 6, 01.05.2018, p. 1706-1718.e1.

Research output: Contribution to journalArticle

Tzartzeva, Kristina ; Obi, Joseph ; Rich, Nicole E. ; Parikh, Neehar D. ; Marrero, Jorge A. ; Yopp, Adam ; Waljee, Akbar K. ; Singal, Amit G. / Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis : A Meta-analysis. In: Gastroenterology. 2018 ; Vol. 154, No. 6. pp. 1706-1718.e1.
@article{2a053d7c3e634071831919be6f515e01,
title = "Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis",
abstract = "Background & Aims: Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis. Methods: Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Results: Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84{\%} sensitivity (95{\%} confidence interval [CI] 76{\%}–92{\%}), but early-stage HCC with only 47{\%} sensitivity (95{\%} CI 33{\%}–61{\%}). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95{\%} CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95{\%} CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95{\%} CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63{\%} sensitivity (95{\%} CI 48{\%}–75{\%}) and 45{\%} sensitivity (95{\%} CI 30{\%}–62{\%}), respectively (P =.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84{\%} sensitivity (95{\%} CI 70{\%}–92{\%}). Conclusions: We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.",
keywords = "Alpha Fetoprotein, Liver Cancer, Screening, Ultrasound",
author = "Kristina Tzartzeva and Joseph Obi and Rich, {Nicole E.} and Parikh, {Neehar D.} and Marrero, {Jorge A.} and Adam Yopp and Waljee, {Akbar K.} and Singal, {Amit G.}",
year = "2018",
month = "5",
day = "1",
doi = "10.1053/j.gastro.2018.01.064",
language = "English (US)",
volume = "154",
pages = "1706--1718.e1",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis

T2 - A Meta-analysis

AU - Tzartzeva, Kristina

AU - Obi, Joseph

AU - Rich, Nicole E.

AU - Parikh, Neehar D.

AU - Marrero, Jorge A.

AU - Yopp, Adam

AU - Waljee, Akbar K.

AU - Singal, Amit G.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background & Aims: Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis. Methods: Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Results: Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P =.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%–92%). Conclusions: We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.

AB - Background & Aims: Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis. Methods: Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Results: Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P =.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%–92%). Conclusions: We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.

KW - Alpha Fetoprotein

KW - Liver Cancer

KW - Screening

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85046449007&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046449007&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2018.01.064

DO - 10.1053/j.gastro.2018.01.064

M3 - Article

C2 - 29425931

AN - SCOPUS:85046449007

VL - 154

SP - 1706-1718.e1

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 6

ER -