Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arborr, MI 48109, USA.
Aliment Pharmacol Ther. 2009 Jul;30(1):37-47. doi: 10.1111/j.1365-2036.2009.04014.x. Epub 2009 Apr 8.
A majority of studies investigating the accuracy of ultrasound for detecting hepatocellular carcinoma (HCC) do not reflect how this test is used for surveillance vs. diagnosis.
To determine the performance characteristics of surveillance with ultrasound for the detection of HCC, particularly early HCC as defined by the Milan criteria.
A systematic literature review using the MEDLINE and SCOPUS databases yielded six studies that evaluated the accuracy of ultrasound for HCC at any stage and 13 studies that were specific to early HCC.
Surveillance ultrasound detected the majority of tumours before they presented clinically, with a pooled sensitivity of 94%. However, ultrasound was less effective for detecting early HCC with a sensitivity of 63%. Alpha-fetoprotein provided no additional benefit to ultrasound. Meta-regression analysis demonstrated a significantly higher sensitivity for early HCC with ultrasound every 6 months than with annual surveillance. Current studies have limitations such as verification bias and are of suboptimal quality.
Surveillance with ultrasound demonstrates limited sensitivity for early HCC, although this may be improved by testing at 6-month intervals. Currently available evidence evaluating surveillance ultrasound has significant limitations and future studies are necessary to determine optimal surveillance methods for early HCC.
大多数研究调查了超声检测肝细胞癌 (HCC) 的准确性，但并未反映该检测在监测与诊断方面的应用情况。
旨在确定超声监测 HCC 检测的性能特征，特别是根据米兰标准定义的早期 HCC。
使用 MEDLINE 和 SCOPUS 数据库进行系统文献综述，共获得了 6 项评估任何阶段 HCC 超声准确性的研究，以及 13 项专门针对早期 HCC 的研究。
监测性超声在肿瘤出现临床症状前多数可检测到，其总体敏感性为 94%。然而，超声对早期 HCC 的检测效果较差，敏感性为 63%。甲胎蛋白对超声检查没有额外的帮助。Meta 回归分析显示，每 6 个月而非每年进行超声监测的早期 HCC 敏感性更高。目前的研究存在验证偏倚等局限性，且质量欠佳。
尽管每 6 个月检测可提高超声监测早期 HCC 的敏感性，但监测性超声对早期 HCC 的敏感性有限。目前评估监测性超声的证据存在显著局限性，需要进一步研究来确定早期 HCC 的最佳监测方法。
