Ultrasound Helps Spot Early Liver Cancer

Reuters Health Information

Biannual Ultrasound Helps Spot Early Liver Cancer

Jun 26, 2013

By David Douglas

NEW YORK (Reuters Health) Jun 26 - In cirrhotic patients, biannual ultrasonography may have advantages over annual computed tomography for detecting early hepatoma, researchers suggest.

Whether early detection will reduce mortality is another question, however.

"No appropriately designed study has ever shown a mortality benefit" of screening for early hepatocellular carcinoma (HCC), said study coauthor Dr. Christine Pocha, of Minneapolis VAHCS System, Minnesota, in email to Reuters Health.

"More importantly," she continued, "surveillance programs must recognize the limitations in HCC surveillance tests and treatment efficacy in specific patient populations."

Still, she added, ultrasound screening has been recommended for more than a decade. Alpha-fetoprotein (AFP) levels were used until recently as well, although that marker has now been dropped officially because of a lack of sensitivity.

There's no consensus on screening intervals, however, and now some providers have started to use computed tomography (CT), as Dr. Pocha's team points out in a June 10 online paper in Alimentary Pharmacology and Therapeutics.

In the current study, the researchers sought to evaluate CT screening, thinking it would detect smaller tumors at lower overall cost.

They randomized 163 Veterans Health Administration patients with compensated cirrhosis to biannual ultrasonography (US) or yearly triple-phase-contrast CT. In addition, patients had AFP testing twice per year.

The HCC incidence was 6.6% per year. Nine HCCs were detected by US and eight by CT. Sensitivity and specificity rates, respectively, were 71.4% and 97.5% with US vs 66.7% and 94.4% with CT.

The biannual AFP testing added little to overall HCC detection, the investigators say. They add, however, that its cost was low, and one patient was identified by increasing AFP level, although initial imaging was negative.

But while 58.8% of HCCs were detected at an early stage, only 23.5% of patients received potentially curative treatment, and only one patient received a liver transplant. HCC-related mortality was 70.5% and overall mortality was 82.3%, suggesting that most patients died of their cancer.

The researchers conclude that biannual US was marginally more sensitive and less costly than annual CT for detecting early HCC. Because of the costs and the risks involved in CT, they say it "should not be used as screening tool for a population at risk for HCC."

Advances in screening technologies and HCC treatments "may provide further incremental improvements in the cost/effectiveness equation," Dr. Pocha told Reuters Health.

But in the meantime, her team concludes in its paper, "The overall efficacy of HCC surveillance in a cirrhotic population in the United States has yet to be demonstrated, and further research is needed."

SOURCE: http://bit.ly/1afuQLP

Aliment Pharmacol Ther 2013.

Summary

Background

Guidelines recommend screening for hepatocellular cancer (HCC) with ultrasonography. The performance of ultrasonography varies widely. Computed tomography (CT) is less operator dependent.

Aim

To compare the performance and cost of twice-a-year ultrasonography to once-a-year triple-phase-contrast CT for HCC screening in veterans. We hypothesised that CT detects smaller HCCs at lower overall cost.

Method

One hundred and sixty-three subjects with compensated cirrhosis were randomised to biannual ultrasonography or yearly CT. Twice-a-year alpha-feto protein testing was performed in all patients. Contingency table analysis using chi-squared tests was used to determine differences in sensitivity and specificity of screening arms, survival analysis with Kaplan–Meier method to determine cumulative cancer rates. Multivariate logistic regression models were used to examine predictive factors.

Results

Hepatocellular cancer incidence rate was 6.6% per year. Nine HCCs were detected by ultrasonography and eight by CT. Sensitivity and specificity were 71.4% and 97.5%, respectively, for ultrasonography vs. 66.7% and 94.4%, respectively, for CT. Although 58.8% of screen-detected HCC were early stage (Barcelona Clinic Liver Cancer stage A), only 23.5% received potentially curative treatment despite all treatment options being available. HCC-related and overall mortality were 70.5% and 82.3%, respectively, in patients with screen-detected tumour. Overall costs were less for biannual ultrasonography than annual CT.

Conclusions

Biannual ultrasonography was marginally more sensitive and less costly for detection of early HCC compared with annual CT. Despite early detection, HCC-related mortality was high. These data support the use of biannual ultrasonography for HCC surveillance in a US patient population (NCT01350167).

Xem Nguy cơ biến chứng HCC ở bệnh nhân viêm gan mạn

Ultrasound and Osteoporosis

www.portableultrasoundmachines.net/ultr...

There is an insidious nature to osteoporosis. It is a gradual loss of bone tissue that is so slow that it is usually not noticed until there is a traumatic event like a fracture. Screens exist that can predict osteoporosis and allow treatment to begin early, and one of the best screens is ultrasound based.

Quantitative ultrasound (QUS) measures the speed of sound and broad band ultrasonic attenuation of the ultrasound beam as it passes between two ultrasound transducers. QUS can become a screen that may be predict future fractures in peri-menopausal and immediate post-menopausal women, and senior citizens of both genders. Those who have low QUS values for the ankle bone, the most common bone screened, are referred for further testing, like measurements of the spine.

QUS works by measuring how the ultrasound machine beam changes as it passes through the bone. The name for this type of ultrasound is Broad Band Ultrasonic Attenuation, or BUA. QUS can also measure how quickly the ultrasound beam passes through the patient’s bone; the name for this is Speed of Sound, abbreviated as SOS.

These two readings when taken together can tell us about how bones are structured, whether or not they are elastic, and how strong they are—in short, measures of the quality of the bone. That can be compared to the bone density. Taken together, these two assessments can help doctors predict each patient’s risk of suffering a bone fracture.

The bones of the foot are used because just like the lumbar spine, as we age these bones change. Spinal changes cause the majority problems in patients with osteoporosis. In addition, QUS is a simple process, the equipment is portable, and for the patient there is no radiation exposure.

In the three-year multicenter study, 6,174 women age 70 to 85 with no previous formal diagnosis of osteoporosis were screened with heel-bone quantitative ultrasound (QUS), a diagnostic test used to assess bone density. QUS was used to calculate the stiffness index, which is an indicator of bone strength, at the heel. Researchers added in risk factors such as age, history of fractures or a recent fall to the results of the heel-bone ultrasound to develop a predictive rule to estimate the risk of fractures. The results showed that 1,464 women (23.7 percent) were considered lower risk and 4,710 (76.3 percent) were considered higher risk.
Study participants where mailed questionnaires every six months for up to 32 months to record any changes in medical conditions, including illness, changes in medications or any fracture. If a fracture had occurred, the patients were asked to specify the fracture's precise location and trauma level and to include a medical report from the physician in charge.
In the group of higher risk women, 290 (6.1 percent) developed fractures whereas only 27 (1.8 percent) of the women in the lower risk group developed fractures. Among the 66 women who developed a hip fracture, 60 (90 percent) were in the higher risk group.
The results show that heel QUS is not only effective at identifying high-risk patients who should receive further testing, but also may be helpful in identifying patients for whom further testing can be avoided.
"Heel QUS in conjunction with clinical risk factors can be used to identify a population at a very low fracture probability in which no further diagnostic evaluation may be necessary".

 Studies have shown that a combination of QUS and an inquiry about personal and familial risk factors would detect more cases of osteoporosis and had slightly better chance to predict fractures than the risk factors inquiry alone. It has also been discovered that ultrasound test alone have much better predictive value than risk factors alone. It is, however, still good clinical practice to do an overall assessment of risk for osteoporosis rather than QUS alone.

Ultrasound machine scanning, therefore, is a simple, quick, safe, portable, and inexpensive clinical test. It can provide physicians an opportunity to improve on the current method of identifying patients at risk for osteoporosis and the associated fractures.