Hepatocellular carcinoma detected by regular surveillance: Does timely confirmation of diagnosis matter?

Background: Although current guidelines recommended surveillance of hepatocellular carcinoma, prognosis in patients undergoing enhanced follow-up has yet to be evaluated. Aims: Examine outcomes of hepatocellular carcinoma diagnosed during enhanced follow-up. Methods: During 2010-2012, 194 patients underwent ultrasonography surveillance were diagnosed with hepatocellular carcinoma and divided into: (A) immediate diagnosis (N = 105, 54.1%) after positive ultrasonography, (B) enhanced follow-up: (N = 38, 19.6%) for initial negative recall procedures, (C) late call back: (N = 28, 14.4%) recall procedures were deferred after positive ultrasonography, and (D) beyond ultrasonography: (N = 23, 11.9%) surveillance ultrasonography had been negative. Results: Median time from positive ultrasonography to confirmation of hepatocellular carcinoma were 9.5 months (2-67) in the Group B and 6.5 months (3-44) in the Group C. Stage distribution and 3-year survival rates were similar amongst all Groups. Surveillance intervals longer than 6 months were associated with the non-curative stage (3.7% vs. 12.5%, p = 0.04). Nine (4.6%) patients underwent surveillance were diagnosed as Barcelona-Clinic Liver Cancer stage C. Conclusion: Enhanced follow-up by current guidelines is appropriate that treatment can be deferred until a definite diagnosis. Despite optimal surveillance interval and recall policies, few non-curative stage diagnoses seemed inevitable under current standard of care.