Hepatocellular carcinoma detected by regular surveillance: Does timely confirmation of diagnosis matter?

Background: Although current guidelines recommended surveillance of hepatocellular carcinoma, prognosis in patients undergoing enhanced follow-up has yet to be evaluated. Aims: Examine outcomes of hepatocellular carcinoma diagnosed during enhanced follow-up. Methods: During 2010-2012, 194 patients underwent ultrasonography surveillance were diagnosed with hepatocellular carcinoma and divided into: (A) immediate diagnosis (N = 105, 54.1%) after positive ultrasonography, (B) enhanced follow-up: (N = 38, 19.6%) for initial negative recall procedures, (C) late call back: (N = 28, 14.4%) recall procedures were deferred after positive ultrasonography, and (D) beyond ultrasonography: (N = 23, 11.9%) surveillance ultrasonography had been negative. Results: Median time from positive ultrasonography to confirmation of hepatocellular carcinoma were 9.5 months (2-67) in the Group B and 6.5 months (3-44) in the Group C. Stage distribution and 3-year survival rates were similar amongst all Groups. Surveillance intervals longer than 6 months were associated with the non-curative stage (3.7% vs. 12.5%, p = 0.04). Nine (4.6%) patients underwent surveillance were diagnosed as Barcelona-Clinic Liver Cancer stage C. Conclusion: Enhanced follow-up by current guidelines is appropriate that treatment can be deferred until a definite diagnosis. Despite optimal surveillance interval and recall policies, few non-curative stage diagnoses seemed inevitable under current standard of care. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).