P76 The ‘Traffic Light System’ – a radiology-led pathway for hepatocellular carcinoma surveillance in patients with liver cirrhosis

<h3>Background</h3> Patients with liver cirrhosis are at greater risk of developing hepatocellular carcinoma (HCC).¹ Delivering an effective HCC surveillance programme increases the likelihood of diagnosing HCC at an early stage; there is currently no UK framework for its implementation.² 6-monthly ultrasound scans (USS) are recommended to enable expedited diagnosis, and improved outcomes but interpreting results and re-booking scans is a time-consuming administrative process for clinicians.³ Additionally, patients can be lost-to-follow-up due to human error associated with future bookings. With the prevalence of cirrhosis predicted to rise over the coming years,^{4 5} increasing demand on these programmes, we developed a radiology-led pathway using our ‘Traffic Light System’ (TLS). We aimed to develop a safe and effective process that does not require clinician involvement. <h3>Aims</h3> a) Assess the safety of the TLS by identifying any patients where no follow up imaging took place without a decision to stop surveillance b) Determine the number of patients where HCC was diagnosed through the TLS c) Assess the effectiveness of the diagnostic imaging pathway once an alert was issued <h3>Methods</h3> A flowchart (figure 1) and associated USS report templates and actions were developed following consultations between sonographers, radiologists and hepatologists. Our TLS cohort included all patients with cirrhosis enrolled in US liver surveillance at our hospital between 01/03/2021 – 28/02/2022. Booked USS were identified over the following two years, up to 01/03/2024. The patient notes, USS requests and reports were assessed. <h3>Results</h3> 220 patients were included in the cohort. 3 patients (1.4%) were lost-to-follow up; 1 due to US team not booking, 2 due to gastroenterologist not re-starting TLS following an amber warning. Focal liver lesions were identified in 18 patients (8.1%), all of these progressed to automatic Magnetic Resonance Imaging (MRI), requested by the US team. Cancer was diagnosed in 9 patients (4.0%). Median time between US and MRI was 11 days. 16 patients (7.3%) died during surveillance, 9 (56%) of which were due to end-stage-liver disease. <h3>Conclusions</h3> We have developed, implemented and assessed a novel, multidisciplinary and straightforward HCC surveillance programme collaboratively between radiology and hepatology. The TLS is a safe, effective, and efficient method of managing regular US surveillance for HCC which reduces clinicians’ administrative burden. It limited the opportunity for human error in this vital process which we believe leads to a robust liver cirrhosis US surveillance programme with the potential to be adopted in other units. <h3>References</h3> European association for the study of the liver, european organisation for research and treatment of cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.<i> J Hepatol</i>. 2012;<b>56</b>:908–43. Suddle A, Reeves H, Hubner R, <i>et al</i>. British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults. <i>Gut</i>. 2024;gutjnl-2023–331695. Taylor EJ, Jones RL, Guthrie JA, <i>et al</i>. Modeling the benefits and harms of surveillance for hepatocellular carcinoma: information to support informed choices. <i>Hepatol Baltim Md.</i> 2017;<b>66</b>:1546–55. Estes C, Anstee QM, Arias-Loste MT,<i> et al</i>. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030. <i>J Hepatol</i>. 2018;<b>69</b>:896–904. Huang DQ, Terrault NA, Tacke F,<i> et al</i>. Global epidemiology of cirrhosis — aetiology, trends and predictions. <i>Nat Rev Gastroenterol Hepatol</i>. 2023;<b>20</b>:388–98.