Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B
Liver cancer is a leading cause of death among people with chronic hepatitis B infection. Screening such patients with ultrasound of the liver or alpha-foetoprotein in the blood, or both, is widely performed to detect liver cancer at an early stage. The hope is that early stages of liver cancer can be treated by resection or transplantation, or both, with improved outcomes. Only three trials could be included in this review. One of these trials was conducted in Shanghai, China. It compared screening twice yearly with ultrasound and alpha-foetoprotein against no screening. The trial has a high risk of systematic errors (bias) and several published reports of the trial provide different results. Another trial was conducted in Toronto, Canada. It compared screening with alpha-foetoprotein and ultrasound versus screening with alpha-foetoprotein alone. This trial had too few participants. As there were no participants who were not screened, we cannot assess whether screening is effective in reducing mortality. The remaining trial was published as an abstract only. It was designed to determine the optimal time interval for screening using alpha fetoprotein and ultrasound. The cumulative four-year survival was not significantly different between the two studied screening intervals of four months and 12 months. Thus, to date, there is insufficient evidence regarding screening for liver cancer among patients with chronic hepatitis B infection.
Available from: Zhi Dai
- "The diagnosis of HCC without pathologic confirmation can be achieved by assessing the serum alpha-fetoprotein (AFP) level combined with imaging techniques, including ultrasonography, magnetic resonance imaging, and computerized tomography [31,32]. However, improvement in early diagnosis is still needed because only 44% of the patients are diagnosed at a localized disease stage, and only 30% of patients with HCC are candidates for potentially curative treatments at the time of diagnosis . "
[Show abstract] [Hide abstract]
ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world. Currently, surgical resection, liver transplantation, and local ablation are considered curative therapeutic practices for HCC. The diagnosis of HCC without pathologic confirmation is achieved by analyzing serum alpha-fetoprotein (AFP) levels combined with imaging techniques, including ultrasonography, magnetic resonance imaging, and computerized tomography. Although progress has been made in the diagnosis and management of HCC, its prognosis remains dismal. Various new technologies have identified numerous novel biomarkers with potential diagnostic as well as prognostic value, including Dickkopf-1 and Golgi protein 73. These biomarkers not only help in the early diagnosis and prediction of prognosis, but also assist in identifying potential targets for therapeutic interventions. In this article, we provide an up-to-date review of the biomarkers that are used for early diagnosis, prognosis prediction, and personalized treatment of HCC.
- "Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor and usually occurs in the setting of cirrhosis and chronic hepatitis B and C infections. Earlier detection of HCC allows initiation of curative therapy and for this, surveillance in cirrhotic patients is performed with alpha-fetoprotein testing and sonography. Sonographic features of HCC are variable with sensitivity as low as 20.5% to as high as 81%. "
[Show abstract] [Hide abstract]
ABSTRACT: Recent advances in radiology have greatly increased the ability to make highly accurate diagnosis. Biopsy of many commonly seen lesions is no longer performed as the radiological findings are pathognomonic. This gives rise to the concept of 'virtual biopsy', a term coined on the lines of other imaging techniques such as virtual colonoscopy. Virtual biopsy is not a new imaging technique but a new concept which refers to the use of existing imaging modalities to evaluate the morphological features of tumors and arriving at a non-invasive diagnosis with a high degree of confidence obviating the need for true biopsy. Elements of virtual biopsy have already been incorporated into some evidence-based guidelines, and it is expected that with further technological advancements, an increasing number of tumors may be diagnosed and managed accordingly. A wider acceptance of virtual biopsy could further reduce the need for invasive biopsies and its attendant costs and risks. In this review article, we use index cases to further emphasize this concept.
Available from: biosciencetrends.com
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.