ISG Hybrid Winter Meeting 2022

AUDIT AWARDS - FIRST PRIZE

Nada Ibrahim
Cork University Hospital

“Surveillance Practices for HCC in Patients with Chronic Hepatitis B; A Single Centre Audit”

TBA (22W119)

Surveillance Practices for HCC In Patients with Chronic Hepatitis B; A Single Centre Audit

Author(s)

N Ibrahim, M Blair, D Coleman, J Joyce, K Fitzmaurice, A Jackson

Department(s)/Institutions

Infection disease department Cork University Hospital (Cork)

Introduction

Hepatitis B patients are at increased risk of developing hepatocellular carcinoma (HCC). International guidelines recommend regular surveillance for high-risk patients. However, the European Association of study of the liver (EASL) and American Association of study of the liver (AASLD) guidelines differ on who is at high risk.

Aims/Background

To gather data on Hepatitis B surveillance practices to determine if high-risk patients are being identified and screening requested in compliance with international guidelines.

Method

We assessed 117 patients attending the hepatitis B clinic over 2 months at Cork University Hospital from April 2021. Demographics, frequency of Ultrasound (US) requests, and Alpha-fetoprotein (AFP) were collected. Eligibility for surveillance was determined by AASLD and EASL guidelines.

Results

All patients had AFP recorded: partial screening was completed in all. As per AASLD, 17(14.4%) patients were identified as high risk compared to 15 (12.8%) as per EASL. Of 17 eligible by AASLD, only 3 (17%) were referred for US. Of 15 eligible by EASL, 1 (6%) was referred for screening. Over 80% of high-risk patients had US in the preceding 5 years.

Conclusions

HCC screening is complex. We need better identification of high-risk patients and better pathways/protocols to facilitate repeated ultrasounds. Despite universal adherence to AFP testing, US screening was sub-optimal. The standard of 6 monthly screening is a high bar to achieve in our setting. No new cases of HCC were identified in this cohort.