Role of the routine use of chest computed tomography and bone scan in staging workup of hepatocellular carcinoma

Abstract

Background & aims: The value of chest computed tomography (CT) and bone scan (BS) during initial staging workup for hepatocellular carcinoma (HCC) patients has not been evaluated in a large patient group.

Methods: A prospective cohort of 381 patients who were initially diagnosed as having HCC at our institution between 2008 and 2010 was enrolled. We evaluated whether chest CT and BS could affect Barcelona Clinic Liver Cancer (BCLC) and Union for International Cancer Control (UICC) (7th) staging, compared with liver dynamic CT (LDCT) and chest X-ray.

Results: Abnormal findings on chest CT and BS were observed in 59.6% and 52.8% of 381 patients, respectively. Thirty and eight patients, respectively, had truly metastatic intrathoracic and bone lesions, with 19 (49.8%) and 7 (87.5%) exhibiting the same lesions on LDCT or chest X-ray. Of the 381 patients, 60 (15.7%), 134 (35.2%), 61 (16.0%), 119 (31.2%), and 7 (1.8%) had BCLC stages 0, A, B, C, and D, respectively; 176 (46.2%), 83 (21.8%), 41 (10.8%), 39 (10.2%), 0 (0%), 8 (2.1%), and 34 (8.9%) had UICC stages I, II, IIIA, IIIB, IIIC, IVA, and IVB, respectively before chest CT and BS. Only three of 381 patients showed a shift in BCLC stage [B→C (3/61, 4.9%)]. Chest CT and BS revealed additional metastases in only 1.1%, 14.0%, and 5.6% of patients with UICC stage T2, T3a, and T3b, respectively.

Conclusions: Chest CT and BS do not provide additional information on metastasis in HCC patients with BCLC 0, A, C, or D stages, and UICC T1 or T4 stages on LDCT.