Value of Follow-Up Chest Computed Tomography in the Surveillance of Patients with Hepatocellular Carcinoma

Purpose To evaluate the value of follow-up chest CT in the surveillance of HCC patients. Background Imaging guidelines for the surveillance of hepatocellular carcinoma (HCC) patients recommend multiple follow-up computed tomography (CT) examinations of the chest, abdomen, and pelvis. Imaging studies are a major driver of rising healthcare costs. The appropriate use of imaging studies must be evaluated to provide valued health care. Methods We reviewed the radiology reports of baseline and follow-up chest, abdominal, and pelvic CT examinations of HCC patients. We categorized the incidence of malignancy in the chest and abdomen for the baseline and follow-up examinations. We also categorized the follow-up examinations as showing improved disease, stable disease, or disease progression. We correlated any progression of disease in the chest with progression of disease in the abdomen. We determined the extent to which disease progression in the chest occurred alongside that in the abdomen. Descriptive statistical analysis was carried out using R (version 3.5.2, R Development Core Team). Results Of the 226 patients included in our study, only 7 (3%) had disease progression in the chest without corresponding disease progression in the abdomen and pelvis on follow-up CT. Only 1.8% of patients with disease progression in the chest had a negative CT chest at baseline. Conclusion Follow-up chest CT has limited benefit in the surveillance of HCC patients, especially those with negative baseline chest CT findings.