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dc.contributor.authorSadler, L
dc.contributor.authorJones, H
dc.contributor.authorWhiting, P
dc.contributor.authorRogers, M
dc.contributor.authorWatt, K
dc.contributor.authorCramp, M
dc.contributor.authorRyder, S
dc.contributor.authorStein, K
dc.contributor.authorWelton, N
dc.contributor.authorOppe, F
dc.contributor.authorBell, J
dc.contributor.authorRogers, G

<ns4:p>Background Liver cirrhosis is the largest risk factor for developing hepatocellular carcinoma (HCC), and surveillance is therefore recommended among this population. Current guidance recommends surveillance with ultrasound, with or without alpha-fetoprotein (AFP). This review aims to synthesise the evidence on the diagnostic accuracy of imaging or biomarker tests, alone or in combination, to identify HCC in adults with liver cirrhosis in a surveillance programme. Methods We will identify studies through a 2021 Cochrane review with similar eligibility criteria, and a database search of MEDLINE, Embase and the Cochrane Database of Systematic Reviews. We will include diagnostic test accuracy studies with adult cirrhosis patients of any aetiology. Studies must assess at least one of the following index tests: ultrasound (US), magnetic resonance imaging (MRI), computerised tomography (CT), alpha-fetoprotein (AFP), des-gamma-carboxyprothrombin (DCP), lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), a genomic biomarker, or a diagnostic prediction model incorporating at least one of the above-mentioned tests. We will assess studies for risk of bias using QUADAS-2 and QUADAS-C. We will combine data using bivariate random effects meta-analyses. For tests evaluated across varying diagnostic thresholds, we will produce pooled estimates of sensitivity and specificity across the full range of numerical thresholds, where possible. Where sufficient studies compare two or more index tests, we will perform additional analyses to compare the accuracy of different tests. Where feasible, we will stratify all meta-analyses by tumour size and patient characteristics, including cirrhosis aetiology and liver disease severity. Discussion: This review will synthesise evidence across the full range of possible surveillance tests, using advanced statistical methods to summarise accuracy across all thresholds and to compare the accuracy of different tests. PROSPERO registration CRD42022357163</ns4:p>

dc.publisherNational Institute for Health and Care Research
dc.subject32 Biomedical and Clinical Sciences
dc.subject3202 Clinical Sciences
dc.subjectLiver Disease
dc.subjectRare Diseases
dc.subjectLiver Cancer
dc.subjectChronic Liver Disease and Cirrhosis
dc.subjectBiomedical Imaging
dc.subjectDigestive Diseases
dc.subject4 Detection, screening and diagnosis
dc.subject4.2 Evaluation of markers and technologies
dc.subject3 Good Health and Well Being
dc.titleDiagnostic accuracy of serological and imaging tests used in surveillance for hepatocellular carcinoma in adults with cirrhosis: a systematic review protocol
plymouth.publication-statusPublished online
plymouth.journalNIHR Open Research
plymouth.organisational-group|Plymouth|Research Groups
plymouth.organisational-group|Plymouth|Faculty of Health
plymouth.organisational-group|Plymouth|Research Groups|Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group|Plymouth|Research Groups|Institute of Translational and Stratified Medicine (ITSMED)|CBR
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA
plymouth.organisational-group|Plymouth|Users by role
plymouth.organisational-group|Plymouth|Users by role|Academics
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA|UoA01 Clinical Medicine
plymouth.organisational-group|Plymouth|Faculty of Health|Peninsula Medical School

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