Ultrasound surveillance for hepatocellular carcinoma: service evaluation of a radiology-led recall system in a tertiary-referral centre for liver diseases in the UK.

AIM: To review the radiology-led ultrasound (US) surveillance programme for the detection of hepatocellular carcinoma (HCC) in cirrhotic patients in a UK tertiary-referral centre. MATERIALS AND METHODS: The radiology information system was searched for patients who had undergone US for surveillance of cirrhosis from September 2009 to May 2013. Patient demographics and cirrhosis aetiology were documented. Data including numbers of surveillance scans, abnormal findings suspicious for HCC, subsequent radiological investigations, numbers of HCC and survival for HCC patients were recorded. Service performance data, such as rates of attendance and rebooking, were also recorded. RESULTS: Eight hundred and four patients entered surveillance and 2,366 surveillance US examinations were performed; 368 (46%) underwent follow-up (6-monthly US). Abnormalities leading to further radiological investigations were found in 81 patients. Reasons for incomplete surveillance included non-attendance and radiology failure to re-book appointments. HCC was diagnosed in 22 patients. Fourteen had HCC diagnosed on a surveillance scan, eight had HCC diagnosed on a scan performed for other reasons. Patients diagnosed with HCC on a surveillance scan were more likely to be treated with curative intent and had longer survival. CONCLUSION: Even with a radiology-led recall service for HCC surveillance, the proportion of patients receiving scans 6-monthly was low, due in part to the lack of organisational support that is available for other screening programmes. This study gives a realistic representation of the implementation of surveillance in a UK hospital at the current time and of the rates of HCC proceeding to treatment.

Protection against immune haemolytic disease of newborn infants by maternal monocyte-reactive IgG alloantibodies (anti-HLA-DR).

The extent to which maternal anti-Rh(D) antibodies support lysis of erythrocytes by monocytes in the antibody-dependent cell-mediated cytotoxicity (ADCC) assay is closely correlated with the severity of Rh(D) haemolytic disease of the newborn infant (HDN). However, in some cases HDN is much milder than would be predicted from the ADCC value. We postulated that maternal ADCC-blocking alloantibodies against paternal antigens on monocytes can protect these infants against severe haemolysis. We studied 13 severely Rh(D)-alloimmunised mothers whose infants showed unexpectedly mild HDN (group I) and 14 women with similar ADCC values but whose infants had severe HDN (group II). 7 group-I women had monocyte-reactive IgG alloantibodies that inhibited lysis by paternal monocytes in the ADCC. No such antibodies were found in group II (p less than 0.01). In 6 of the 7 serum samples with monocyte-reactive antibodies, the antibodies had HLA-DR specificity. Our findings suggest that Rh(D)-positive children of some severely Rh(D)-alloimmunised women may be protected from severe HDN by maternal non-HLA-class-I, IgG alloantibodies against paternal monocyte blood-group antigens. These antibodies may inhibit the mononuclear phagocyte system of the fetus.