Department of Gastroenterology, Asan Medical Center, Seoul, South Korea.
Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
PLoS One. 2022 Sep 16;17(9):e0274747. doi: 10.1371/journal.pone.0274747. eCollection 2022.
Abdominal ultrasonography (US) is the backbone of hepatocellular carcinoma (HCC) surveillance. Although previous studies have evaluated clinical factors related to surveillance failure, none have focused specifically on US blind spots.
This study included 1,289 patients who underwent 6 months intervals surveillance using US and serum alpha-fetoprotein (AFP) and were eventually diagnosed with single-nodular HCC. Patients were divided into US-detected group (n = 1,062) and US-missed group (HCC detected only by AFP ≥ 20ng/mL; n = 227). Blind spots consisted of four locations: hepatic dome, caudate lobe or around the inferior vena cava, <1 cm beneath the ribs, and the surface of the left lateral segment. Both groups were compared by HCC location, proportional distribution, treatment method, and overall survival.
A higher proportion of HCCs were located within blind spots in the US-missed group than in the US-detected group (64.3% vs. 44.6%, P < 0.001). HCC ≥ 2 cm detected in blind spots was higher than in non-blind areas (60.3% vs. 47.1%, P = 0.001). Blind spot HCCs were more treated with surgery, whereas those located in a non-blind area were more treated with local ablation. Patients with an HCC located within a blind spot in the US-detected group had better overall survival than the same in the US-missed group (P = 0.008).
Using the current surveillance test, blind spots affected the initially detected HCC tumor size, applicability of the treatment modality, and overall survival. Physicians should pay attention to US blind spots when performing US-based HCC surveillance.
腹部超声（US）是肝细胞癌（HCC）监测的基础。虽然以前的研究已经评估了与监测失败相关的临床因素，但没有一项研究专门针对 US 盲点。
本研究纳入了 1289 例接受 6 个月间隔超声和血清甲胎蛋白（AFP）监测并最终诊断为单发结节性 HCC 的患者。患者分为 US 检测组（n = 1062）和 US 漏诊组（仅通过 AFP≥20ng/mL 检测到 HCC；n = 227）。盲点包括四个位置：肝顶、尾状叶或下腔静脉周围、肋下<1cm 处和左外侧段表面。通过 HCC 位置、比例分布、治疗方法和总生存率比较两组。
US 漏诊组 HCC 位于 US 检测组盲点内的比例高于 US 检测组（64.3%比 44.6%，P<0.001）。在盲点内检测到的 HCC≥2cm 比在非盲点内更高（60.3%比 47.1%，P=0.001）。盲点内 HCC 更倾向于手术治疗，而非盲点内 HCC 更倾向于局部消融治疗。在 US 检测组中，位于 US 盲点内的 HCC 患者的总生存率优于 US 漏诊组（P=0.008）。
使用当前的监测测试，盲点会影响最初检测到的 HCC 肿瘤大小、治疗方式的适用性和总体生存率。医生在进行基于 US 的 HCC 监测时应注意 US 盲点。
