PWE-283 Surveillance for hepatocellular carcinoma: a clinical audit

IntroductionIt is thought that mortality due to hepatocellular carcinoma (HCC) is rising in the Western world. This has been primarily attributed to the hepatitis C viral epidemic.1 HCC detected after the development of symptoms carries an extremely poor prognosis (0–10 per cent survival at 5 years),2 whereas those detected at surveillance can often be cured. One study demonstrated reduced mortality of 37% in cirrhotic patients undergoing 6 monthly surveillance with ultrasound scanning (USS) and α fetoprotein (AFP) levels; this method is currently recommended by the BSG.3 However, the American Association for the study of Liver Diseases (AASLD) now advocates 6 monthly USS without AFP testing: studies showed that AFP levels increased detection rate but also increased false positive detection rates with an added cost of $2000 to $3000 per tumour found.4 The clinical lead for hepatology in Swansea, Dr C L Ch'ng, has primarily adopted these guidelines.MethodsA list of 246 patients entered into the HCC surveillance programme between January 2006 and December 2011 was reviewed and the frequency of USS and AFP levels measured for each patient was recorded. 62 patients were excluded:20 DNAs14 new patients13 had insufficient data12 developed serious comorbidities or died before follow-up was complete3 were inappropriate for surveillanceResults were compared with standards set by BSG and AASLD guidelines.Results184 patients were appropriate for surveillance183 had at least 1 USS168 had at least 2 USS114 had 6–12 monthly USS95 (52%) had 6 monthly USS (recommended by AASLD)48 (26%) received 6 monthly USS and AFP levels (current BSG recommendation).ConclusionSurveillance of cirrhotic patients for HCC is currently suboptimal, with poor adherence to national guidelines. There is evidence that patients engaged initially but timing of subsequent USS and AFP teasting was erratic. Despite this, results are favourable in comparison with a large US study of cirrhotic hepatitis C carriers which demonstrated routine surveillance in only 12% of patients. Results did not differ widely from similar departmental audits carried out in the last 5 years. Suggestions for the future include routine 6 monthly postal invitation to screening with facilitated access to scans, together with education of both patients and treating clinicians regarding HCC risk. This should ideally be carried out within an established local surveillance scheme.Competing interestsNone declared.References1. Serag