BACKGROUND A majority of studies investigating the accuracy of ultrasound for detecting hepatocellular carcinoma (HCC) do not reflect how this test is used for surveillance vs. diagnosis. AIM To determine the performance characteristics of surveillance with ultrasound for the detection of HCC, particularly early HCC as defined by the Milan criteria. METHODS A systematic literature review using the MEDLINE and SCOPUS databases yielded six studies that evaluated the accuracy of ultrasound for HCC at any stage and 13 studies that were specific to early HCC. RESULTS Surveillance ultrasound detected the majority of tumours before they presented clinically, with a pooled sensitivity of 94%. However, ultrasound was less effective for detecting early HCC with a sensitivity of 63%. Alpha-fetoprotein provided no additional benefit to ultrasound. Meta-regression analysis demonstrated a significantly higher sensitivity for early HCC with ultrasound every 6 months than with annual surveillance. Current studies have limitations such as verification bias and are of suboptimal quality. CONCLUSIONS Surveillance with ultrasound demonstrates limited sensitivity for early HCC, although this may be improved by testing at 6-month intervals. Currently available evidence evaluating surveillance ultrasound has significant limitations and future studies are necessary to determine optimal surveillance methods for early HCC.

中文翻译：

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荟萃分析：超声监测肝硬化患者早期肝细胞癌。

背景 调查超声检测肝细胞癌 (HCC) 准确性的大多数研究并未反映该测试如何用于监测与诊断。目的 确定超声监测检测 HCC 的性能特征，尤其是米兰标准定义的早期 HCC。方法 使用 MEDLINE 和 SCOPUS 数据库的系统文献综述产生了 6 项评估超声诊断任何阶段 HCC 准确性的研究和 13 项针对早期 HCC 的研究。结果 超声监测在临床出现之前就检测到了大多数肿瘤，综合敏感性为 94%。然而，超声检测早期 HCC 的效率较低，灵敏度为 63%。甲胎蛋白没有为超声提供额外的好处。Meta 回归分析表明，每 6 个月超声检查对早期 HCC 的敏感性明显高于年度监测。当前的研究存在验证偏倚等局限性，并且质量欠佳。结论 超声监测表明对早期 HCC 的敏感性有限，尽管这可以通过每隔 6 个月进行检测来改善。目前可用的评估超声监测的证据有很大的局限性，未来的研究对于确定早期 HCC 的最佳监测方法是必要的。结论 超声监测表明对早期 HCC 的敏感性有限，尽管这可以通过每隔 6 个月进行检测来改善。目前可用的评估超声监测的证据有很大的局限性，未来的研究对于确定早期 HCC 的最佳监测方法是必要的。结论 超声监测表明对早期 HCC 的敏感性有限，尽管这可以通过每隔 6 个月进行检测来改善。目前可用的评估超声监测的证据有很大的局限性，未来的研究对于确定早期 HCC 的最佳监测方法是必要的。