The following is a summary of the “Blood-based biomarkers for hepatocellular carcinoma screening: Approaching the end of the ultrasound era?,” published in the January 2023 issue of Hepatology by Parikh, et al.
One reason hepatocellular carcinoma (HCC) is so deadly is that its early detection methods are sorely lacking in most parts of the world. Patients with cirrhosis and demographic subgroups with chronic hepatitis B infection should undergo screening every 6 months using abdominal ultrasonography with or without serum alpha-fetoprotein. However, inadequate early-stage sensitivity, false positives with subsequent harms, inter-operator variability in ultrasound performance, and low adherence are some of the problems with this screening technique.
Some obstacles could be eliminated if a blood-based biomarker is adequately performed for early-stage illness. However, a biomarker’s test performance characteristics must be understood through a multistep validation process before it can be used for screening in clinical practice. Case control and subsequent validation in prospective cohorts of high-risk patients are two processes. Until recently, there were not enough longitudinal validation cohorts for early HCC detection; however, several validation cohorts are maturing, such as the Hepatocellular Carcinoma Early Detection Study and the Texas Hepatocellular Carcinoma Consortium, which will allow for rigorous validation of candidate biomarkers.
There are several intriguing biomarkers in the process of being validated, but to replace abdominal ultrasound, a candidate biomarker must demonstrate sufficient test performance and overcome practical barriers. In light of the drawbacks of ultrasound-based screening, the potential of blood-based biomarkers is especially promising; nonetheless, they need to be adequately validated, and various logistical barriers must be solved before they can be implemented clinically.
Source: sciencedirect.com/science/article/pii/S0168827822030677
