Surveillance failure in ultrasound for hepatocellular carcinoma: a systematic review and meta-analysis

Recently, various advances have been achieved in the diagnosis and treatment of hepatocellular carcinoma (HCC).1 We read with great interest the paper by De Toni et al 2 demonstrating the importance of early diagnosis of HCC by surveillance with respect to survival benefits, and that by Zeng et al 3 emphasising risk stratifications in HCC surveillance. As these papers suggest, effective surveillance to detect early stage HCC is crucial in the management of patients at-risk. Although ultrasound (US) is recommended as a standard surveillance modality,4 5 the sensitivity of US for detecting early stage HCC is suboptimal, being only 47%.6 Updated guidelines suggest alternative surveillance tools including MRI in patients likely to have inadequate US examinations.4 5 Recently, MRI surveillance, including abbreviated MRI-protocols, has been drawing attention because of its high diagnostic performance compared with US.7 8 However, considering its cost and availability, MRI surveillance cannot be applied to all at-risk patients, but should be done in patients who are prone to US surveillance failures and benefit from MRI surveillance. Thus, we conducted a meta-analysis to evaluate the incidence …