SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Pierre-Emmanuel RAUTOU
Coup de coeur :
 
 
Gastroenterology
  2018/05  
 
  2018 May;154(6):1706-1718.e1.  
  doi: 10.1053/j.gastro.2018.01.064.  
 
  Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis.  
 
  Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, Waljee AK, Singal AG  
  https://www.ncbi.nlm.nih.gov/pubmed/29425931  
 
 

Abstract

BACKGROUND & AIMS:

Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis.

METHODS:

Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.

RESULTS:

Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%-92%), but early-stage HCC with only 47% sensitivity (95% CI 33%-61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83-0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71-0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05-1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%-75%) and 45% sensitivity (95% CI 30%-62%), respectively (P = .002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%-92%).

CONCLUSIONS:

We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.

 

  
Question posée
 
Quelle est la performance du dépistage du carcinome hépatocellulaire avec et sans alphafoetoprotéine ?
  
Question posée
 
L’échographie hépatique seule a une faible sensibilité pour détecter les carcinomes hépatocellulaires à un stade précoce. L’ajout de l’alphafoetoprotéine augmente significativement la sensibilité de détection des carcinomes hépatocellulaires à un stade précoce en pratique clinique.
  
Commentaires

Cette large métananalyse repose la question de l’utilisation de l’alphafoetoprotéine pour la détection des carcinomes hépatocellulaires à un stade précoce. Elle montre aussi les limites de l’échographie seule pour détecter les carcinomes hépatocellulaires de petite taille. 
 
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