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

Objective Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related deaths in the UK. The British Society of Gastroenterology and the European Association for the Study of the Liver recommend ultrasound scans (USS) biannually to survey high-risk patients. Implementing this can be labour-intensive and introduces significant clinical risk. We developed a radiology-led HCC surveillance (HCC-S) pathway—the ‘Traffic Light System’ (TLS)—allowing for protocolised booking of scans based on a colour coding system and associated protocols. We evaluated our service to assess safety, efficacy and provide practical implementation guidance. Methods A single-site, retrospective cohort study of patients undergoing HCC-S as part of the TLS was undertaken. Patients receiving USS surveillance between March 2021 and February 2022 were included and reviewed over an up to a 3-year follow-up period until March 2024. If 6 monthly follow-up did not occur or if new pathology was identified, notes were reviewed to determine outcomes. Results In total, 909 USS were completed under the TLS for 220 patients. Eight patients (3.6%) were diagnosed with HCC. Apparent non-adherence with HCC-S protocol was identified in 38 patients (17.3%). On further review, 10 patients (4.5%) were truly non-adherent to HCC-S. Administrative errors were identified in three patients (1.3%). Conclusion We have established a radiology-led HCC-S programme that we believe to be robust, effective and reliable with an adherence rate of 95.5% over up to 3 years. Therefore, this may be a template for other services to follow when establishing HCC-S programmes.