Introduction: Intro: Liver cancer is the fastest growing cause of cancer-related deaths in the U.S. Guidelines recommend biannual HCC screening using ultrasound (US), with or without serum alpha-fetoprotein (AFP) measurement in at-risk patients. HCC screening in at risk individuals is associated with improved early detection, greater likelihood of curative treatment, and improved outcomes. The sensitivity of recommended tools for early-stage cancer detection remain sub-optimal. Better screening techniques have been developed and are currently under investigation. One such commercially available approach is the multi-target HCC blood test (mt-HBT, Oncoguard® Liver), analyzes blood-based biomarker, (methylated DNA and AFP) to aid in the detection of early-stage HCC. The real-world benefits of these new approaches are being seen. We report a case demonstrating the benefit of mt-HBT for diagnosis & early treatment of HCC.
Case Description/Methods: Case report: 69 yo male, with cirrhosis, was referred for evaluation and treatment. Patient's etiology of cirrhosis was presumed to be related to NASH due to negative serologic testing and patient's history of obesity with BMI over 40 for greater than 30 years. Liver biopsy was refused by the patient. HCC screening guidelines were initiated. Initial screening, with US and AFP were negative. Six months later, an US and mt-HBT, was used for screening. US was negative, but mt-HBT was positive. Follow-up MRI with and without contrast was negative for HCC. Per patient's request, he was referred to an academic transplant center, where a repeat MRI imaging study and GALAD calculations were negative for HCC. Because of positive mt-HBT, patient had repeat imaging studies 4 months later. A 1.3 cm HCC lesion was found in the right lobe of the liver. Radiofrequency ablation of the HCC was performed and follow up imaging studies one month later showed no evidence of residual tumor.
Discussion: The overall goal of HCC screening is to detect disease earlier, reducing morbidity and mortality. This case demonstrates the benefit using the mt-HBT. While further study is needed, given the initial negative standard HCC screening technique (AFP, US, MRI, & GALAD), an isolated positive mt-HBT, may warrant more frequent HCC screening. This patient demonstrates benefits of early diagnosis; less invasive treatment options leading to cure of HCC. How to use the mt-HBT in post HCC cure needs further investigation, but this case demonstrates the benefit of the mt-HBT.
