Surveillance and Diagnosis of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) surveillance has been shown to improve early tumor detection, curative treatment receipt, and overall survival. Therefore, several professional societies, including the American Association for the Study of Liver Diseases (AASLD), recommend HCC surveillance every 6 months in at-risk patients, including those with cirrhosis. (Table 1) Although there have been increasing reports of HCC developing in patients with noncirrhotic nonalcoholic fatty liver disease (NAFLD), this population is not currently included in surveillance guideline recommendations. A large cohort study of patients with NAFLD from the Veterans Affairs health system suggests that although 20% of patients with NAFLD do not have cirrhosis at the time of HCC diagnosis, the annual incidence rate is too low for surveillance to be cost-effective. The most recent AASLD guidelines incorporated key changes to HCC surveillance and diagnostic algorithms, including inclusion of alpha-fetoprotein (AFP) for surveillance and assimilation of Liver Imaging Reporting and Data System (LI-RADS) criteria for HCC diagnosis. Herein, we review these updated recommendations for surveillance and diagnosis.