Outcomes of National Survey of the Practice of Hepatocellular Carcinoma Surveillance

Abstract

Robert A Scott,1,2 Timothy J S Cross,3 Christopher Clarke,4 Shahid A Khan,5 Stephen D Ryder,1 James Franklin,6,* Aloysious D Aravinthan1,2,* 1NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; 2Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; 3Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK; 4Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK; 5Division of Digestive Diseases, Imperial College London, London, UK; 6Institute of Medical Imaging and Visualisation, Bournemouth University, Bournemouth UK*These authors contributed equally to this workCorrespondence: James Franklin, Institute of Medical Imaging and Visualisation, Bournemouth University, Bournemouth Gateway Building, St Paul’s Lane, Bournemouth, BH8 8GP, UK, Email [email protected] Aloysious D Aravinthan, Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK, Email [email protected] & Aim: HCC has significantly improved outcomes when detected early. Guidelines recommend biannual surveillance with ultrasound (US) and/or AFP in at-risk individuals. This survey aimed to describe HCC surveillance adherence/practices amongst the NHS hospitals in the UK.Methods: An electronic survey was sent to 79 NHS hospitals via the British Association for the Study of the Liver distribution list. The responses were captured from July 2021 to January 2022. Centres were divided into hepato-pancreato-biliary (HPB) and non-HPB centres, depending on whether the hospital undertakes major liver surgeries.Results: A total of 39 (49.3%) centres responded: 15 HPB and 24 non-HPB centres from across the UK. HCC surveillance eligibility criteria were universally applied, but heterogeneous approaches occur outside these criteria. Eighty per cent of patients undergoing surveillance were estimated to have cirrhosis. Eighty-five per cent of centres do 6-monthly US and AFP requested by clinicians and liver clinical nurse specialists. Compliance was estimated at 80% but not routinely audited. In most centres, general sonographers and/or radiologists perform surveillance US scans without a standard reporting template, although structured reporting was viewed as desirable by the majority. Poor views on US are approached heterogeneously, with patients variably offered ongoing US, CT, or MRI with different protocols.Conclusion: Most responding NHS hospitals follow 6-monthly HCC surveillance guidance. Data recording is variable, with limited routine data collection regarding compliance, yield, and quality. Surveillance US is mostly performed by non-HPB specialists without standardised reporting. There is an inconsistent approach to poor views with US surveillance. Even in a universal healthcare system such as NHS, which is free at the point of care, delivery of HCC surveillance has not improved over the last decade and remains variable.Keywords: hepatocellular carcinoma, primary surveillance, ultrasound scan, cirrhosis, liver cancer

Keywords

• hepatocellular carcinoma primary surveillance ultrasound scan adherence