4.Failure of hepatocellular carcinoma surveillance: inadequate echogenic window and macronodular parenchyma as potential culprits
Yeun Yoon KIM ; Chansik AN ; Do Young KIM ; Khalid Suliman ALJOQIMAN ; Jin Young CHOI ; Myeong Jin KIM
Ultrasonography 2019;38(4):311-320
PURPOSE: The purpose of this study was to examine the associations between ultrasonography (US) quality and clinical outcomes in patients undergoing surveillance for hepatocellular carcinoma. METHODS: Between 2008 and 2013, 155 patients were diagnosed with liver cancer during regular surveillance by positive US results (US group, n=82) or by computed tomography (CT) or magnetic resonance image (MRI) scanning as alternative modalities (CT/MRI group, n=73). The quality of the echogenic window, macronodularity of the liver parenchyma, and occurrence of surveillance failure (initial tumor diagnosis beyond the Milan criteria or at Barcelona Clinic Liver Cancer stage B or C) were evaluated. Overall survival was compared according to whether surveillance failure occurred. RESULTS: The patients in the CT/MRI group with negative US results had a higher proportion of parenchymal macronodularity on US than those in the US group (79.5% vs. 63.4%, P=0.028). Surveillance failure tended to be more common in the US group than in the CT/MRI group (40.2% vs. 26.0% by the BCLC staging system [P=0.061]). In the US group, surveillance failure occurred more frequently when the echogenic window was inadequate (50.0% vs. 19.4% by the Milan criteria [P=0.046]). Significantly poorer 5-year overall survival was associated with surveillance failure (P≤0.001). CONCLUSION: Parenchymal macronodularity hindered the detection of early-stage tumors during US surveillance. Using an alternative imaging modality may help prevent surveillance failure in patients with macronodular parenchyma on US. Supplemental surveillance strategies than US may also be necessary when the echogenic window is inadequate.
Carcinoma, Hepatocellular
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Diagnosis
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Humans
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Liver
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Liver Neoplasms
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Population Surveillance
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Ultrasonography
10.Application of capture-mark-recapture method on evaluating the abilities of birth defects surveillance systems.
Xun-Qiang YIN ; Ya-Man LI ; Jia-You LUO ; Xiao-Juan SHI ; Ting YIN ; Rui HUANG ; Jing CHEN
Chinese Journal of Epidemiology 2008;29(2):155-157
OBJECTIVETo evaluate the abilities of population-based birth defects surveillance system (PBBDSS) and hospital-based birth defects surveillance system(HBBDSS).
METHODSWe used capture-mark-recapture method(CMR) to analyze the data of the two kinds of birth defects surveillance systems from 1 Oct. 2006 to 31 Dec. 2006 in a county of Hunan province. Data from PBBDSS were defined as the first source and data from HBBDSS were defined as the second source.
RESULTS49 and 28 birth defect cases were found from PBBDSS and from HBBDSS respectively. Among these cases, 20 were marked. With the method of CMR, the estimated birth defects cases were 68 (95% CI: 56-70). The coincident rates of PBBDSS and HBBDSS were 72.1% and 41.2%, while the total coincident rates was 83.8% and the coincident rates from different sources was 57.1%. The unreported rates of PBBDSS and HBBDSS were 27.9% and 58.8%.
CONCLUSIONNot only the HBBDSS but also the PBBDSS appeared to have had high unreported rates, suggesting that we could use CMR to adjust the rate of birth defects from the birth defects surveillance data.
Congenital Abnormalities ; diagnosis ; epidemiology ; Humans ; Infant, Newborn ; Population Surveillance ; methods