Clin Mol Hepatol.  2012 Jun;18(2):185-194. 10.3350/cmh.2012.18.2.185.

Comparison of usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B endemic area

• Bae SY
• Choi MS
• Gwak GY
• Paik YH
• Lee JH
• Koh KC
• Paik SW
• Yoo BC

• KMID: 1743726
• DOI: http://doi.org/10.3350/cmh.2012.18.2.185

Abstract

BACKGROUND/AIMS
We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area.
METHODS
We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines.
RESULTS
The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm.
CONCLUSIONS
The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.

Keyword

Comparison; Clinical diagnostic criteria; Hepatocellular carcinoma

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*diagnosis/etiology/pathology
Female
Hepatitis B/complications/*diagnosis/epidemiology
Hepatitis B Surface Antigens/blood
Hepatitis C/diagnosis/epidemiology
Humans
Liver/pathology
Liver Neoplasms/*diagnosis/etiology/pathology
Magnetic Resonance Imaging
Male
Middle Aged
Practice Guidelines as Topic
Predictive Value of Tests
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Young Adult
alpha-Fetoproteins/analysis