Eliciting Patient Preferences for Hepatocellular Carcinoma Screening: A Choice-Based Conjoint Analysis.

BACKGROUND: Abbreviated MRI (AMRI), proposed as an alternative imaging modality for hepatocellular carcinoma screening, provides higher sensitivity than ultrasound. It is, however, unknown how patients weigh the higher sensitivity of AMRI against its higher cost and potentially less desirable testing experience. PURPOSE: To assess patient preferences for hepatocellular carcinoma screening test attributes including sensitivity, false-positive rate, test-related anxiety, cost, and need for intravenous catheterization and contrast use, measured by choice-based conjoint analysis. MATERIALS AND METHODS: This was an ancillary study to two prospective dual-center studies designed to compare the hepatocellular carcinoma detection rates by ultrasound versus AMRI. Of the 135 eligible participants, 106 (median age 63, range 25-85; 56% male) completed the choice-based conjoint analysis survey and were included in this substudy. Participants' preference for individual screening test attributes was assessed using a 12-item, web-based choice-based conjoint analysis survey administered in person at the screening visit. Conjoint analyses software and hierarchical Bayes random-effects logit model were used to calculate the relative importance of each attribute. RESULTS: The most important attribute driving patient preferences was higher test sensitivity (importance score 39.8%), followed by lower cost (importance score 22.8%) and lower false-positive rate (importance score 19.4%). The overall estimated participants' preference for ultrasound and AMRI were similar when assuming the same specificity for both modalities. CONCLUSION: Higher screening test sensitivity and lower cost were the leading patient preference drivers. This study has important implications for understanding patient preferences for specific screening test characteristics as potential determinants of adherence.

Hepatocellular Carcinoma in Patients With Liver Cirrhosis Secondary to Autoimmune Hepatitis: A Case Series and Literature Review.

Autoimmune hepatitis (AIH) is a known risk factor for the development of hepatocellular carcinoma (HCC). However, the current clinical guidelines do not offer a systematic approach to the surveillance and follow-up of patients with AIH to help with the diagnosis and treatment of HCC in this patient population. In this case series, we describe the clinical presentation and management of eight patients who were diagnosed with HCC secondary to underlying AIH at the University of Florida Health Shands Hospital. Throughout their treatment course, all eight patients were identified to have either histological or radiological evidence of liver cirrhosis. Furthermore, all of them tested negative for chronic viral hepatitis serologies and denied any history of excessive alcohol consumption. The median time interval between AIH diagnosis and HCC development in this cohort was 48 months. All demographic, clinical, and laboratory findings were summarized and compared to the relevant data in the existing literature. Our findings suggest that patients diagnosed with AIH would benefit from liver cirrhosis screening and, if present, they should adhere to a regular HCC surveillance schedule.

Did AFP-L3 save ultrasonography in community screening?

In the community screening, those subjects with elevated serum alpha-fetoprotein (AFP) required further abdomen ultrasonography (US) to detect hepatocellular carcinoma (HCC). However, some chronic hepatitis patients might have elevated AFP. AFP-L3, has been proposed to differentiate HCC and hepatitis in elevated AFP cases in Japan for decades, but the utility is limited outside Japan. We conducted this study to elucidate the role of AFP-L3 in the community and the possibility of saving unnecessary US. A total of 56,702 subjects underwent a large-scale healthcare screening in Tainan county in 2004. Among them, 286 residents with AFP more than 20 ng/ml further received US and 169 (59%) had stored baseline sera were enrolled into this study in 2013. Their AFP and AFP-L3 levels were further detected. HCC patients were initially identified through US and personal history. Among 169 studied sera, only 148 (87.6%) samples still had AFP level more than 20 ng/ml after a 10-years frozen period. The decrease of AFP level was significant (481.3 ± 2093.8 ng/ml and 456.1 ± 2095.3 ng/ml in paired-T test, p < 0.001). Focusing on these 148 cases, 23 (15.5%) HCC cases were diagnosed at the baseline screening. There was no difference of AFP-L3 level between HCC and non-HCC cases. Using AFP-L3 to predict HCC, the area under Receiver Operating Characteristic curve was as low as 52%, p = 0.757. Too long frozen period might lower the quality of stored sera. Additionally, AFP-L3 might not provide more information for HCC identification to save advanced US examinations in the community screening.

Screening for hepatocellular carcinoma in high-risk populations.

Screening for hepatocellular carcinoma (HCC) should be implemented in the high-risk population. High-risk population includes patients with cirrhosis of any etiology, patients with chronic hepatitis B virus with or without cirrhosis, and patients with chronic hepatitis C virus with cirrhosis. A randomized controlled trial of over 18,000 high-risk individuals demonstrated that biannual screening reduced HCC-related mortality by 37%. The screening test of choice is ultrasound imaging with an interval of 6 months.