Impact of COVID-19 pandemic on hepatocellular carcinoma ultrasound surveillance volumes at a united states liver transplant center

ABSTRACT

Purpose: The COVID-19 pandemic led to nationwide postponement of outpatient preventative health services. The purpose of our study was to determine the effect of the COVID-19 pandemic on hepatocellular carcinoma ultrasound (HCC US) surveillance volumes at a liver transplant center. Material(s) and Method(s) This retrospective study examined ultrasound volumes across the first two years of the pandemic (March 1, 2020, to February 28, 2022) compared to a baseline year (March 1, 2019, to February 28, 2020). Monthly and annual surveillance volumes, cumulative number of positive ultrasound examinations, and rate of follow-up CT or MRI on an US-3 observation were compared using paired t-tests. Result(s) A total of 6765 ultrasound examinations for HCC at our institution were performed over the three-year study period 2507 in the baseline year, 1943 in the first year, and 2345 in the second year, representing a 24% (p = 0.036) and 6% (p = 0.144) decline in volume, respectively, compared to baseline. The first pandemic year had the greatest decline (mean 159/month, range 8-217, versus baseline year mean 209/month, range 182-241/month;p = .0363). The most dramatic reductions were in March, April, and May, in which 111, 8, and 126 surveillance ultrasound examinations were performed, respectively. In the baseline year, 95 (4%) had an US-3 observation (1 cm or larger nodule at ultrasound) and 63 (66%) underwent followup CT or MRI. In the first pandemic year, 64 (3%, p = 0.016) patients had an US-3 observation and 48 (75.00%, p = 0.0584) underwent follow-up CT or MRI. In the second pandemic year, 65 (3%, p = 0.001) patients had an US-3 observation and 48 (74%, p = 0.040) underwent follow-up CT or MRI. Conclusion(s) The significantly decreased surveillance ultrasound volume during the pandemic led to fewer positive surveillance studies and therefore fewer recommendations for follow-up imaging. As frequent surveillance is critical to HCC management, the pandemic is expected to have a significant impact on HCC epidemiology in the future.