Digestive Diseases and Sciences

, Volume 59, Issue 12, pp 3073–3077 | Cite as

Hepatocellular Carcinoma Surveillance: A National Survey of Current Practices in the USA

  • Kartik Joshi
  • Michel Mendler
  • Robert Gish
  • Rohit Loomba
  • Alexander Kuo
  • Heather Patton
  • Yuko Kono
Original Article



The incidence rate of hepatocellular carcinoma (HCC) in the USA is rapidly rising. Surveillance using biannual ultrasound (US) is recommended, but actual practices are unknown.


To determine current HCC surveillance practices among gastroenterology and hepatology providers in the USA.


A 21-question electronic survey was emailed to 12,485 gastroenterology and hepatology providers in the USA. The survey contained questions concerning provider background, surveillance practices, and opinions. Pearson chi-square and multivariate logistic regression tests were used to analyze the data.


We received 777 responses (6.2 % response rate); 656 were eligible for analysis. 92 % place cirrhotic patients under surveillance independent of etiology, 79 % exclusively use a 6-month interval, and 77 % use alpha-fetoprotein. While 93 % use US, only 36 % use US exclusively and 60 % use two or more imaging modalities. Providers from transplant centers favor using additional imaging modalities, instead of only US. Multivariate analysis showed transplant center providers who allocate more time to patient care (OR 1.96, p = 0.004) and see more cirrhotic patients (OR 2.07, p = 0.033) have increased odds of using additional imaging modalities.


Participating providers reported very high rates of surveillance utilization and use of a biannual interval. It is likely that the sample is composed of providers who are very engaged and informed about HCC surveillance. However, their surveillance imaging practices largely deviated from practice guidelines, which all recommend only using US. Providers affiliated with transplant centers tend to use additional imaging modalities such as computed tomography and MRI, instead of US only.


Hepatocellular carcinoma Surveillance Ultrasound National survey 



Wako Diagnostics provided grant support for our data collection through the American Medical Association. Wako was not involved in any research activities up to and including study design, data analysis, data interpretation, and manuscript preparation and manuscript revisions.

Confilct of interest



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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kartik Joshi
    • 1
  • Michel Mendler
    • 1
  • Robert Gish
    • 2
  • Rohit Loomba
    • 1
  • Alexander Kuo
    • 1
  • Heather Patton
    • 1
  • Yuko Kono
    • 1
  1. 1.UCSD Medical CenterSan DiegoUSA
  2. 2.Stanford UniversityStanfordUSA

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