ARRS 2022 Abstracts


E1276. Hepatocellular Carcinoma Screening in Incidentally Detected Cirrhotic Emergency Room Imaging
  1. Kyle Stumetz; Providence Sacred Heart Medical Center
  2. Scott King; Providence Sacred Heart Medical Center
  3. Cody Key; Providence Sacred Heart Medical Center
  4. Winston Joe; Providence Sacred Heart Medical Center
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. It accounts for 75–85% of all primary liver cancers, and approximately 90% of HCC cases arise from patients with cirrhotic liver morphology. Despite the widespread availability of HCC surveillance, many patients with cirrhosis often have a delayed time interval to diagnosis as well as a delayed time to screening. The focus of the present study was to identify how often incidentally detected cases of cirrhosis were found in the emergency department (ED) setting and to ascertain how often these patients received appropriate HCC screening follow-up.

Materials and Methods:
CT and ultrasound (US) radiologic reports were searched for the terms “cirrhosis” or “cirrhotic” from January 1–September 30, 2019. For those with positive imaging reports, chart review was performed to identify patients without documented history of cirrhosis who presented to the ED for non-hepatobiliary complaints. This target patient population was followed for 18 months after initial ED imaging to determine if HCC screening was performed. Additionally, charts were utilized to determine discharging provider referral rates, patient adherence rates, and to assess the impact of PCP follow-up visits on HCC screening outcomes.

Of 521 patients with CT and US findings of cirrhosis, 157 (30%) were found to have incidentally detected cirrhosis at a follow-up screening rate of 0.6–17.8%. Twenty-eight (17.8%) patients had some form of one-time screening during the 18-month follow-up period, 19 (12.1%) patients had screening within the first 6 months after the initial scan, and only 1 (0.6%) patient received serial 6-month HCC screening during the 18-month follow-up period. Mean age was statistically different for patients who did not receive screening compared to those who did (65.2 vs 57.2 years, p = 0.005); however, mean BMI (29.6 vs 27.4, p = 0.087) and FIB-4 score (4.6 vs 7.0, p = 0.117) were not statistically different between non-screened and screened individuals, respectively. For the 157 incidentally detected cases of cirrhosis, mean age, BMI, and FIB-4 fibrosis scores were 63.8 years (95% CI, 61.5–66.1), 29.18 (95% CI, 28.1–30.2), and 5.05 (95% CI, 4.16–5.94). respectively.

Incidental liver cirrhosis is a common finding on ED CT and US imaging that presents a significant opportunity for systemic improvement. In the present study, 30% of patients with cirrhotic imaging findings had not been previously diagnosed with cirrhosis, and only 0.6%–12.1% of these patients received appropriate HCC screening/hepatology referral over the interval 18-month follow-up period.