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TORONTO HEPATOCELLULAR CARCINOMA SCREENING PROTOCOL (THSP): INITIAL NORTH AMERICAN EXPERIENCE WITH SYSTEMATIC IMPLEMENTATION OF AMERICAN ASSOCIATION FOR STUDY OF LIVER DISEASE (AASLD) HEPTOMA SCREENING AND WORKUP GUIDELINES
K Khalili*1, M Sherman2, H Jang1, T Kim1, M Haider1
1Medical Imaging, 2Gastroenterology, University Health Network, Toronto
BACKGROUND: The Toronto Hepatocellular carcinoma Screening Protocol is a systematized clinical screening & workup protocol of patients at risk for hepatocellular carcinoma based on modified AASLD guidelines.
OBJECTIVES: The aim is to describe initial experience with implementation of THSP.
METHODS: A clinical protocol for workup of liver lesions found at screening for HCC was developed in conjunction with hepatology. Imaging criteria for benign, malignant and indeterminate lesions were developed. Lesions <1cm were followed; lesions >2cm were worked up with 4 phase CT; Lesions 1-1.9cm were worked up with 3 contrast enhanced scans: CEUS/4 Phase CT/MR. Imaging was automatically arranged and standardized protocols were used. Results were reviewed prospectively in weekly consensus meeting with 4 outcomes: Treat, Biopsy, Follow, Benign (no follow up). Lesions fulfilling criteria for malignancy on 2/3 modalities for <2cm lesions and on single modality for >2cm lesions were referred for treatment. From Jan-Nov 2006, 80 patients with 118 lesions were enrolled and underwent 58 CEUS, 55 CT, & 57 MR.
RESULTS: 1.5 lesions/pt were seen. Mean and Median lesion size were 1.6cm (SD 0.8) & 1.4cm. 22/118 (19%) lesions were <1cm, 67 (57%) were 1-1.9cm, and 29 (24%) were >2cm. The 2 leading sources of referral were screening US 58/80 (73%) and CT 16/80 (20%). For the 118 lesions, Consensus recommendations were: Treat 27(23%), Biopsy 21 (18%), Follow 39 (33%) and Benign 31 (26%). In Treat category (n=27), 16 were 1-1.9 cm and 11 were >2 cm. 15 were proven malignant by growth or biopsy. In Biopsy category (n=21, all <2cm), 16 underwent biopsy: 4 were malignant, 4 dysplastic, 3 benign, and 5 non-lesional. Overall, 31 lesions in 24/80 (30%) patients were deemed malignant; mean/median lesion sizes were 1.8/1.6 cm (SD 0.9, Range 0.6-4.9cm).
CONCLUSION: Our initial results show successful implementation of a HCC screening/workup program based on AASLD guidelines. 30% of patients referred had a malignancy with Median size of tumors being 1.6 cm. Therefore the THSP has led to detection of considerable number of small malignancies, potentially improving outcomes