Sensitivity of ultrasound in detecting hepatocellular carcinoma in obese patients compared to explant pathology as the gold standard

• Published in: Clinical and molecular hepatology Vol. 26; no. 1; pp. 54 - 59
• Main Authors: Esfeh, Jamak Modaresi, Hajifathalian, Kaveh, Ansari-Gilani, Kianoush
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association for the Study of the Liver 01.01.2020; Korean Association for the Study of the Liver; 대한간학회
• Subjects: liver cirrhosis; neoplasms; obesity; Original; 내과학; Obesity; Liver cirrhosis; Neoplasms
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2019.0039

The American Association for the Study of Liver Diseases recommends ultrasound (US) screening for hepatocellular carcinoma (HCC) among cirrhotic patients, regardless of body mass index (BMI), every 6 months. We examined US sensitivity for diagnosis of HCC in obese patients. Liver transplant patients data with HCC in explant was used (January 2012-December 2017). All patients underwent liver US within 3 months of diagnosis of HCC. Number/size of HCC lesions were extracted from radiologic and pathologic reports. Obesity was defined as BMI ≥30 kg/m2. One hundred sixteen patients were included. 80% were male, with mean BMI of 31 kg/m2. The most common underlying liver disease was hepatitis C virus (62%). At the time of diagnosis, median number of HCC lesions was 2 (interquartile range [IQR], 1-3), and median size of the largest lesion was 2.5 cm (IQR, 1.75-3.9). Overall sensitivity of US study for detection of HCC was 33% (95% confidence interval [CI], 29-48%). Sensitivity was 77% (95% CI, 62-93%) in patients with BMI<30 and 21% (95% CI, 11-30%) in patients with BMI≥30 (P<0.001). Size of the largest HCC lesion (P=0.290) and number of lesions (P=0.505) were not different between groups. Computed tomography (CT) scan detected HCC in 98% of the obese patients with negative US. Sensitivity of US for detection of HCC is significantly lower among obese patients compared to overweight and normal weight patients. These patients may benefit from alternating between US and a different imaging modality.