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Surveillance failure in ultrasound for hepatocellular carcinoma: a systematic review and meta-analysis
  1. Dong Hwan Kim1,
  2. Seung Baek Hong2,
  3. Sang Hyun Choi3,
  4. So Yeon Kim3,
  5. Ju Hyun Shim4,
  6. Ji Sung Lee5,
  7. Joon-Il Choi1,
  8. Suk Kim2
  1. 1Department of Radiology, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  2. 2Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
  3. 3Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
  4. 4Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
  5. 5Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
  1. Correspondence to Dr Sang Hyun Choi, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea; edwardchoi83{at}

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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 al2 demonstrating the importance of early diagnosis of HCC by surveillance with respect to survival benefits, and that by Zeng et al3 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 …

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  • DHK and SBH are joint first authors.

  • Contributors DHK and SBH are co-first authors. SHC contributed to the study concept and design. SHC, DHK and SBH acquired, analysed and interpreted the data. DHK and SHC drafted the manuscript. SHC, DHK and JSL performed statistical analysis. JHS, SYK, J-IC and SK made critical revisions to the manuscript. SHC supervised the study.

  • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (grant number: NRF-2019R1G1A1099743).

  • Competing interests SHC receives research funding from Bayer Healthcare outside the submitted work. J-IlC received research funding from Bayer Healthcare, Guerbet Korea, Bracco Korea, GE Healthcare, and Starmed, and received honorariums from Bayer Healthcare, Samsung Medison, Samsung Electronics, Guerbet Korea, and Bracco Korea outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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