Computed tomography for the diagnosis of hepatocellular carcinoma in chronic advanced liver disease

To assess the diagnostic accuracy of multidetector, multiphasic contrast-enhanced computed tomography (CT) for the diagnosis of hepatocellular carcinoma (HCC) of any size and at any stage in people with chronic advanced liver disease.

  • To assess the diagnostic accuracy of multidetector, multiphasic contrast-enhanced computed tomography for the diagnosis of resectable HCC in people with chronic advanced liver disease. The definition of resectable HCC is a neoplasm amenable to surgical radical resection according to the current guidelines (Milan Criteria): a single lesion with a maximum diameter of less than 5 cm, or fewer than three lesions with a maximum diameter of 3 cm (Mazzaferro 1996).
  • To investigate the following predefined sources of heterogeneity:
    • study date (studies published before the year 2005 compared to studies published after the year 2005, due to advancements in technology);
    • study date (studies published before 2016 compared to studies published after 2016, due to changes in diagnostic criteria);
    • inclusion of participants without cirrhosis (studies including more than 10% participants without cirrhosis compared to studies including less than 10% participants without cirrhosis);
    • study location (population differences): studies conducted in the Americas compared to Europe compared to Asia;
    • participant selection (participants recruited from planned screening programmes compared to clinical cohorts);
    • different HCC stage (studies in which 20% or more of participants have resectable HCC compared to studies in which less than 20% of participants have resectable HCC);
    • different reference standard (histology of the explanted liver compared to liver biopsy compared to another reference standard);
    • different liver cirrhosis aetiology (hepatitis C or hepatitis B virus associated cirrhosis compared to all other aetiologies);
    • number of CT detector rows (exams conducted on 64-slice or fewer compared with more than 64-slice, due to advancements in technology);
    • HCC mean diameter;
    • prevalence of the target condition.

We chose the variables listed above for the following reasons. Due to advancements in technology and change in diagnostic criteria, we considered the date of study publication. The proportion of participants without cirrhosis is relevant because HCC in absence of cirrhosis has different CT characteristics, prognosis, and treatment. There are differences in epidemiology and clinical and radiological characteristics of HCC in Asia and in western countries. Selection of participants can induce variability of results: participants recruited from screening or surveillance programmes may be different mainly in severity of the underlying liver disease and consequently in radiological characteristics of the liver. The HCC prevalence in included studies can change according to selection and epidemiology. The proportion of resectable HCC found in the studies reflects different epidemiology and participant selection. The clinical and radiological characteristics of HCC varies according to the aetiology of the underlying liver disease, mainly in the case of chronic infection with hepatitis C or hepatitis B, compared to other aetiologies. The accuracy of CT may vary according to the diameter of the neoplastic lesion and the number of detector rows in the CT equipment.

This is a protocol.

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