ISG Hybrid Winter Meeting 2022
AUDIT AWARDS - FIRST PRIZE
Cork University Hospital
“Surveillance Practices for HCC in Patients with Chronic Hepatitis B; A Single Centre Audit”
Surveillance Practices for HCC In Patients with Chronic Hepatitis B; A Single Centre Audit
N Ibrahim, M Blair, D Coleman, J Joyce, K Fitzmaurice, A Jackson
Infection disease department Cork University Hospital (Cork)
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.
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.
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.
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.
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.