Non-invasive prediction of development of hepatocellular carcinoma using transient elastography in patients with chronic liver disease

Abstract

Prognosis of patients with chronic liver disease is determined by the extent and progression of liver fibrosis, which may ultimately lead to hepatocellular carcinoma (HCC). Liver biopsy (LB) is regarded as the gold standard to estimate the extent of liver fibrosis. However, because LB has several limitations, the foremost being its invasiveness, several non-invasive methods for assessing liver fibrosis have been proposed. Of these, transient elastography (TE) provides an accurate representation of the extent of liver fibrosis. Furthermore, recent studies have focused on the usefulness of TE for assessing the risk of HCC development and HCC recurrence after curative treatment, and developed novel models to calculate the risk of HCC development based on TE findings. These issues are discussed in this expert review.

Keywords::

• FibroScan^®
• hepatocellular carcinoma
• liver cirrhosis
• liver fibrosis
• liver stiffness
• prediction
• transient elastography

Financial & competing interests disclosure

This study was supported by the Liver Cirrhosis Clinical Research Center, in part by a grant from the Korea Healthcare Technology R & D project, Ministry of Health and Welfare, Republic of Korea (no. HI10C2020). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The funding does not alter our adherence to journal policies on sharing data and materials. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Transient elastography (TE) is regarded as an accurate and highly reproducible method for assessing the degree of liver fibrosis and diagnosing liver cirrhosis in patients with chronic liver disease (CLD).

• Beyond the cross-sectional role of TE in assessing the degree of liver fibrosis at a distinct point in time, TE can also be used for prognostic purposes such as prediction of the development of hepatocellular carcinoma (HCC) in patients with CLD.

• In addition, TE can predict HCC recurrence after curative treatments such as resection and radiofrequency ablation.

• Based on the close relationship between liver stiffness (LS) values assessed using TE and the risk of HCC development, several LS-based HCC prediction models with high accuracy have been developed, although extensive validation is required.

• Further research is needed to confirm whether surveillance programs for HCC development in patients with CLD should be adjusted according to LS values assessed using TE.

Notes