Detection of malignant tumors in end-stage cirrhotic livers: efficacy of sonography as a screening technique

Patients with hepatic cirrhosis are at an increased risk of developing primary malignant tumors of the liver. If these tumors are discovered early, current therapies may be curative. We conducted a prospective study to assess the accuracy of sonographic screening for the detection of malignant tumors in cirrhotic livers as determined by correlation with resected whole livers.

A total of 200 prospectively interpreted preoperative sonograms from 200 patients with cirrhosis who underwent hepatic transplantation were correlated with specimens of freshly resected whole livers. The results were analyzed to determine the sensitivity and specificity of sonography in identifying patients with malignant tumors and detecting individual tumors in each patient.

Pathologic examination showed 80 malignant lesions in 34 patients (28 with hepatocellular carcinoma, three with cholangiocarcinoma, two with metastases, and one with non-Hodgkin's lymphoma) and three hemangiomas in two patients. Sonography correctly showed malignant tumors in 17 of the 34 patients, for a sensitivity of 50%. Sonograms were false-positive for malignant tumors in three patients, two of whom had a total of three hemangiomas. Sonography correctly showed 36 of the 80 malignant lesions, for a lesion sensitivity of 45% and specificity of 98%. Of the 44 missed lesions, 24 were 1 cm or less, 12 were between 1 and 3 cm, and eight were more than 3 cm in diameter.

Our results show that sonography is highly insensitive in the detection of malignant lesions in end-stage cirrhotic livers and thus is not a reliable screening technique. However, because of sonography's very high specificity, any sonographically identified lesion in a cirrhotic liver should be considered malignant until proved otherwise.