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False-Negative Rate of Abdominal Sonography for Detecting Hepatocellular Carcinoma in Patients with Hepatitis B and Elevated Serum {alpha}-Fetoprotein Levels

Tony S. K. Mok1, Simon C. H. Yu2, Conrad Lee1, Joseph Sung3, Nancy Leung3, Paul Lai4, Thomas W. T. Leung1, Anthony T. C. Chan1, Winnie Yeo1, Jane Koh1 and Philip Johnson1

1 Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
2 Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St., Sha Tin, N.T., Hong Kong, China.
3 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
4 Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.



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  		Fig. 1. —Diagram shows scheme of hepatocellular carcinoma early detection program. Note that patients with serum {alpha}-fetoprotein levels greater than 20 ng/mL or focal lesion on abdominal sonograms were further evaluated with Lipiodol ([iodized oil] Guerbet) CT.

 


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  		Fig. 2. —Diagram shows clinical outcome of hepatitis B virus carriers with elevated {alpha}-fetoprotein levels and normal abdominal sonography. Note that false-negative rate of abdominal sonography was 4.3% (3/70). Lipiodol ([iodized oil] Guerbet).

 


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  		Fig. 4. —Screening algorithm shows diagnostic usefulness of Lipiodol ([iodized oil] Guerbet) CT. Note that sensitivity of Lipiodol CT was 85.7%, equal to that of abdominal sonography.

 


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  		Fig. 5. —61-year-old man with hepatitis B and evaluated serum {alpha}-fetoprotein levels. Sonogram shows 1.1-cm well-defined hypoechoic nodule (arrows) in left lobe of liver that was subsequently confirmed to be hepatocellular carcinoma.

 


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  		Fig. 6. —42-year-old woman with hepatitis B and elevated serum {alpha}-fetoprotein levels. Lipiodol ([iodized oil] Guerbet) CT scan shows Lipiodol-accumulating lesion (arrows) in right lobe of liver that was not depicted on sonography and subsequently confirmed to be hepatocellular carcinoma.

 


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  		Fig. 3. —Screening algorithm shows diagnostic usefulness of abdominal sonography. Note that sensitivity of abdominal sonography was 85.7%.

 

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