J Liver Cancer.  2023 Mar;23(1):189-201. 10.17998/jlc.2023.03.11.

Current status of ultrasonography in national cancer surveillance program for hepatocellular carcinoma in South Korea: a large-scale multicenter study

  • 1Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
  • 2Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
  • 3Department of Gastroenterology and Hepatology, Soonchunhyang University College of Medicine, Bucheon, Korea
  • 4Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
  • 7Department of Internal Medicine, St. Vincent`s Hospital, The Catholic University of Korea, Suwon, Korea
  • 8Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea


/Aim: Abdominal ultrasonography (USG) is recommended as a surveillance test for high-risk groups for hepatocellular carcinoma (HCC). This study aimed to analyze the current status of the national cancer surveillance program for HCC in South Korea and investigate the effects of patient-, physician-, and machine-related factors on HCC detection sensitivity.
This multicenter retrospective cohort study collected surveillance USG data from the high-risk group for HCC (liver cirrhosis or chronic hepatitis B or C >40 years of age) at eight South Korean tertiary hospitals in 2017.
In 2017, 45 experienced hepatologists or radiologists performed 8,512 USG examinations. The physicians had a mean 15.0±8.3 years of experience; more hepatologists (61.4%) than radiologists (38.6%) participated. Each USG scan took a mean 12.2±3.4 minutes. The HCC detection rate by surveillance USG was 0.3% (n=23). Over 27 months of follow-up, an additional 135 patients (0.7%) developed new HCC. The patients were classified into three groups based on timing of HCC diagnosis since the 1st surveillance USG, and no significant intergroup difference in HCC characteristics was noted. HCC detection was significantly associated with patient-related factors, such as old age and advanced fibrosis, but not with physician- or machine-related factors.
This is the first study of the current status of USG as a surveillance method for HCC at tertiary hospitals in South Korea. It is necessary to develop quality indicators and quality assessment procedures for USG to improve the detection rate of HCC.


Ultrasonography; Surveillance; Carcinoma, hepatocellular


  • Figure 1. Three aspects of the surveillance test. BMI, body mass index.

  • Figure 2. Brief schematic of hepatocellular carcinoma classification. USG, ultrasound; HCC, hepatocellular carcinoma.



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