Monitoring modalities:
(1) ultrasonography
(2) serum alpha-feto-protein (AFP)
(3) fine needle aspiration of hepatic nodules
(4) other imaging studies (helical CT with contrast, MRI with contrast, and angiography)
Criteria for the diagnosis of hepatocellular carcinoma:
(1) liver nodule
(2) presence of one or more of the following:
(2a) positive fine needle aspiration
(2b) liver nodule > 2 cm in diameter AND two imaging studies showing arterial hypervascularization
(2c) serum AFP > 400 µg/L AND one imaging study with showing arterial hypervascularization
Protocol:
(1) Patients with cirrhosis are monitored every 6 months with ultrasonography and serum AFP.
(2) If no nodules are identified and the serum AFP is not elevated, then the patient continues the screening protocol.
(3) If no nodule is identified but the serum AFP is elevated (level not specified), then a spiral CT is performed to look for a nodule. If no nodule is identified then the patient continues the screening protocol.
(4) If a nodule is found that is < 1 cm then screening is performed every 3 months.
(5) If a nodule is >= 1 cm, then the patient is evaluated to identify one or more criteria for hepatocellular carcinoma as listed above. If negative the patient undergoes frequent evaluation until the diagnosis can be established.
Limitation:
• The method and normal reference range for AFP was not given. The threshold value for AFP to use for monitoring was not given.
