Prospective Multicenter Evaluation of Hepatocellular Carcinoma Surveillance under American Association for the Study of Liver Diseases Version 2023 Guidance
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View abstract on PubMed
Summary
This summary is machine-generated.The 2023 American Association for the Study of Liver Diseases (AASLD) guidance for hepatocellular carcinoma (HCC) surveillance shows improved detection rates. This new approach demonstrated higher sensitivity and negative predictive value compared to previous guidelines.
Area Of Science
- Hepatology
- Oncology
- Medical Imaging
Background
- The American Association for the Study of Liver Diseases (AASLD) released updated 2023 guidance for hepatocellular carcinoma (HCC) surveillance.
- New surveillance triggers include ultrasound (US) visualization score, rising alpha-fetoprotein (AFP) levels, and lesion growth.
- Validation of these new AASLD v2023 triggers was pending.
Purpose Of The Study
- To evaluate the HCC surveillance performance of the AASLD v2023 guidance.
- To compare AASLD v2023 with Liver Imaging Reporting and Data System (LI-RADS) version 2017 (v2017) and AASLD version 2018 (v2018) in high-risk individuals.
- To assess sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for HCC detection.
Main Methods
- Prospective study enrolling high-risk participants undergoing US and AFP surveillance across three institutions (July 2023 - October 2024).
- Compared surveillance performance of US LI-RADS v2017, AASLD v2018, and AASLD v2023.
- Utilized multivariable logistic regression to identify predictors of false-positive and false-negative classifications.
Main Results
- Among 953 participants, 5% (50) had HCC. AASLD v2023 achieved 94% sensitivity and 99.6% NPV for HCC detection.
- AASLD v2023 outperformed US LI-RADS v2017 (60% sensitivity) and AASLD v2018 (76% sensitivity) in HCC detection (P < .001 and P = .02, respectively).
- AASLD v2023 demonstrated lower specificity (84%) compared to US LI-RADS v2017 (90%) and AASLD v2018 (89%). AFP < 20 ng/mL and absence of cirrhosis were associated with false positives.
Conclusions
- The AASLD v2023 guidance significantly improved sensitivity and NPV for HCC surveillance.
- AASLD v2023 surpassed the performance of US LI-RADS v2017 and AASLD v2018 in detecting HCC.
- The findings support the clinical utility of the updated AASLD v2023 guidelines for HCC surveillance.
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