الفهرس 
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Abstract
HCC is one of the most common malignancies worldwide and is a major cause of death, because of its high frequency and poor prognosis. It is also one of few tumors for which a cause could be identified in most cases. It is especially common in Egypt, where it develops on top of cirrhosis secondary to viral hepatitis C and B. And since HCV infection is highly prevalent in Egypt, it accounts to most of the cases of HCC in Egypt.
HCC causes symptoms and signs usually only in advanced stages, so clinical diagnosis in early stages is very rare.
Diagnosis of HCC depends mainly on routine examination using abdominal ultra sound and serum alpha-feto protein levels measurements. In addition to, triphasic spiral CT examination in the presence of suspicious lesion and liver biopsy if needed.
It is important to demarcate the population of cirrhotic patients who are at higher risk of developing HCC. Who in turn would benefit from more strict surveillance and may even require closer period between surveillance dates.
Transient elastography, using FibroScan (by Echosens, Paris, France), is a novel non-invasive method that has been proposed for assessment of liver fibrosis by measuring liver stiffness.
TE correlated strongly with liver biopsy (the golden standard procedure) for the measurement of liver fibrosis, especially in chronic hepatitis C. In addition, it has the advantage of being much less invasive.
The aim of our study was to verify whether transient elastography (FibroScan®), could be used as a marker for identifying Hepatitis C virus positive patients who are at high risk of developing HCC.
The study was conducted on 200 chronic HCV patients, divided into two groups: Non HCC group (G I) included 100 patients with chronic HCV and no evidence of HCC, and the HCC group included 100 patients with HCC on top of chronic HCV as documented by ultrasound, triphasic CT scan, alpha feto protein levels, and histopathological assessment when needed.
Transient elastography measurements (using FIBROSCAN) were taken to all patients in both groups, as well as full clinical assessment, liver biochemical profile, alpha feto protein serum levels, conventional US, abdominal triphasic CT scan, and guided liver biopsy for HCC cases with atypical CT pattern.
Stiffness range was 2.90-39.80 KPa among HCV patients with a mean of 8.95±7.27 kpa, while among HCC patients, its range was 8.40-75.00 KPa with a mean of 31.10±16.05 kpa. Thus showing a high significant difference between the two groups.
Stiffness also showed highly significant sensitivity (97%) and specificity (84%) at the level of >12 KPa. The positive predictive value was 85% and negative predictive value was 96.6%.
However, liver stiffness will not be used as a diagnostic test for HCC but as an indicator of the risk of HCC. In this respect, SSLRs have several advantages over prediction by a fixed cut-off.
In the current study, posttest odds for HCC presence increase 15-fold when stiffness is larger than 25 kPa whereas decrease to less than one-fifth when it is smaller than 10 kPa.
In conclusion, liver stiffness measured by transient elastography is useful in demarcating chronic hepatitis C patients at a high risk for HCC development, who require frequent check-up by imaging examinations. Even if HCC is negative, careful monitoring will be necessary for these patients.