Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma
| Autor: | Matteo Angelo Manini, Angelo Sangiovanni, Fabio Fornari, Marco Biolato, Libera Fanigliulo, Elisa Ravaldi, Antonio Grieco, Massimo Colombo, Aghemo A, Grassi E, Iavarone M, Triolo M, Vavassori S, Giangregorio F, Pompili M, Gian Ludovico R, Riccardi L, De Gaetano AM, Forzenigo LV, Fraquelli M, Michieletti E., PISCAGLIA, FABIO, BOLONDI, LUIGI, GRANITO, ALESSANDRO, LEONI, SIMONA, MARINELLI, SARA, GOLFIERI, RITA |
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| Přispěvatelé: | Matteo Angelo Manini, Angelo Sangiovanni, Fabio Fornari, Fabio Piscaglia, Marco Biolato, Libera Fanigliulo, Elisa Ravaldi, Antonio Grieco, Massimo Colombo, Aghemo A, Grassi E, Iavarone M, Triolo M, Vavassori S, Giangregorio F, Bolondi L, Granito A, Leoni S, Marinelli S, Pompili M, Gian Ludovico R, Riccardi L, De Gaetano AM, Forzenigo LV, Fraquelli M, Golfieri R, Michieletti E. |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Liver Cirrhosis Male Clinical guidelines medicine.medical_specialty Carcinoma Hepatocellular Cirrhosis Hepatocellular carcinoma Settore MED/12 - GASTROENTEROLOGIA Biopsy Fine-Needle Contrast Media Imaging techniques Likelihood ratios in diagnostic testing NaN medicine Humans Prospective Studies Diagnostic Errors Societies Medical Aged Ultrasonography Aged 80 and over Surveillance Cirrhosis Clinical guidelines Hepatocellular carcinoma Imaging techniques Surveillance Hepatology medicine.diagnostic_test business.industry Liver Neoplasms Ultrasound Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging United States Liver biopsy Practice Guidelines as Topic Costs and Cost Analysis Female Radiology Tomography X-Ray Computed Nuclear medicine business Algorithms Contrast-enhanced ultrasound |
| Popis: | BACKGROUND AND AIMS: Although contrast-enhanced computed tomography (CT), dynamic magnetic resonance (MRI) and fine needle biopsy (FNB) are the standard of care to diagnose hepatocellular carcinoma (HCC), the clinical and economic benefits of the updated AASLD diagnostic algorithm, including the drop of contrast enhanced ultrasound (CEUS), have not been previously evaluated. METHODS: 119 de novo liver nodules detected during ultrasound (US) surveillance in 98 cirrhotics, 7 2cm in size, were sequentially examined by CEUS and CT, using MRI as a rescue approach in patients lacking a typical vascular pattern for HCC by one or both contrast techniques in the 1-2cm nodules and by CT in the >2cm nodules. A FNB was performed when required to meet both 2005 and 2010 AASLD criteria. RESULTS: Eighty-four (70%) nodules were HCC: the radiological diagnosis was done in 38 (88%) of those 1-2cm and in 38 (95%) for those >2cm HCCs according to 2010 AASLD criteria. CT or MRI detected 13 HCC nodules that were missed by unenhanced US. Despite an absolute specificity, CEUS failed to identify any HCC uncharacterized by CT or MRI. By updated AASLD criteria, 6 (17%) FNB procedures were spared in patients with 1-2cm nodules (p=0.025), as compared to 2005 criteria. The 2010 vs. 2005 AASLD per patient cost was similar in 1-2cm nodules, 432 € vs. 451 € (p=0.46), but lower in >2cm nodules, 248 € vs. 321 € (p |
| Databáze: | OpenAIRE |
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