Practical screening and early treatment of hepatocellular carcinoma.: Results of a French survey

Aim - To describe French practices for screening hepatocellular carcinoma. Methods - A standardized questionaire was mailed to, all French hospital hepoto-gastroenterologists in June 1999 Results - 411 out of 623 practioners responded (66%). 394 (96%) routinely screen hepatocellular carcinoma, mainly with ultrasound (98%) and mainly at 6-month intervals (77%). Screening was performed in cirrhosis (100%) or extensive fibrosis (54%), independent of the etiology (21%) or the Child-Pugh score of the chronic liver disease (41%), but based on age and treatment feasibility it of a small hypoechogenic nodule was detected in a young patient with compensated HCV-cirrhosis, 59% of proctioners performed a histological examination. In case of non biopsy-proven hepatocellular carcinoma, a second biopsy (49%), treatment (either percutaneous alcohol injection, resection or transplantation) (24%) or an ultrasonographic follow-up (23%) was proposed. In Case of biopsy-proven hepatocellular carcinoma, resection (,49%), transplantation (30%) or percutaneous; alcohol injection (16%) was proposed. Conclusion - Almost all French specialists routinely screen cirrhotic patients for hepatocellular carcinoma, but use somewhat different modalities. In case of small HCC without contraindications to curative treatment, surgical resection is performed in half the patients.