EUS is superior to CT scan for the detection of the Hepatoma: Results of Prospective Controlled Study

Aims: Early detection of Hepatocellular Carcinoma (HCC) and the accurate determination of number of lesions are critical in determining eligibility for liver transplantation. CT and MRI often miss small lesions.

Aim: To compare the accuracy of the EUS with CT scan for the detection of primary tumors of the liver.

Methods: Subjects at high risk of HCC (hepatitis B, hepatitis C or alcoholic cirrhosis) were prospectively enrolled. CT, MRI and EUS examination of the liver were performed.

Results: Seventeen patients were enrolled in the study. EUS-FNA was performed in 16 of the 17 patients with identifiable liver lesions. Diagnosis of primary liver tumors was established in 7 cases (HCC – six; cholangiocarcinoma – one). EUS-FNA established tissue diagnosis in all 7 cases. The diagnostic accuracy of EUS-FNA was significantly higher than the CT scan (100% vs. 69%; p=0.008). EUS detected significantly higher number of total liver lesions (benign and malignant) than CT scan (35 vs. 11; p=0.001). There was no significant difference in accuracy between EUS-FNA and MRI (100% vs. 83%; p=0.09). Accuracy of the EUS-FNA was significantly higher than the “Intention to perform MRI“ (100% vs. 73%; p=0.03). No complications were observed as a result of EUS-FNA.

Conclusions: EUS-FNA is a safe and accurate test for the early diagnosis of HCC. EUS increases the accuracy of intrahepatic staging of the HCC by delineation of lesions, which are missed by CT and MRI. We recommend EUS for suspected HCC, particularly in cases that are being considered for liver transplantation.

	Sens. %	Spec. %	PPV %	NPV %	Accuracy %
CT scan	60 (31.84)	75 (44.93)	60 (31.84)	75 (44.93)	69 (39.90)
MRI	80 (47.96)	86 (53.98)	80 (47.96)	86 (53.98)	83 (51.97)
EUS	100 (76,100)	22 (7.50)	50 (25.75)	100(76,100	56 (31.79)
EUSEUS-FNA	100 (76,100)	100 (76,100)	100 (76,100)	100 (76,100)	100 (76,100)
	% (95 CI)