Materiały źródłowe

• #1 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  Hepatocellular carcinoma (HCC) is responsible for a large proportion of cancer deaths worldwide. HCC is frequently diagnosed after the development of clinical deterioration at which time survival is measured in months. Long-term survival requires detection of small tumors, often present in asymptomatic individuals, which may be more amenable to invasive therapeutic options. Surveillance of high-risk individuals for HCC is commonly performed using the serum marker alfa-fetoprotein (AFP) often in combination with ultrasonography. […] Diagnosis of HCC often requires more sophisticated imaging modalities such as CT scan and MRI, which have multiphasic contrast enhancement capabilities. Confirmation by liver biopsy can be performed under circumstances when the diagnosis of HCC remains unclear.

• #2 Clinical features and diagnosis of hepatocellular carcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hepatocellular-carcinoma

  Clinical features and diagnosis of hepatocellular carcinoma […] The diagnosis of HCC, which can be difficult, often requires the use of one or more imaging modalities. The goal is to detect the tumors when they are ≤2 cm in size so that the entire range of treatment options are available. The five-year survival rate for patients whose tumors are detected at an early stage and who receive treatment exceeds 70 percent. […] This topic discusses the clinical and histologic features of HCC and methods for diagnosis. Our diagnostic approach is generally consistent with guidelines from the American Association for the Study of Liver Diseases (AASLD), the American College of Radiology’s Liver Imaging Reporting and Data System (LI-RADS), and the European Association for the Study of the Liver. […] The selection of patients who warrant surveillance for HCC is discussed separately.

• #3 Clinical features and diagnosis of hepatocellular carcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hepatocellular-carcinoma

  Clinical features and diagnosis of hepatocellular carcinoma […] The diagnosis of HCC, which can be difficult, often requires the use of one or more imaging modalities. The goal is to detect the tumors when they are ≤2 cm in size so that the entire range of treatment options are available. The five-year survival rate for patients whose tumors are detected at an early stage and who receive treatment exceeds 70 percent. […] This topic discusses the clinical and histologic features of HCC and methods for diagnosis. Our diagnostic approach is generally consistent with guidelines from the American Association for the Study of Liver Diseases (AASLD), the American College of Radiology’s Liver Imaging Reporting and Data System (LI-RADS), and the European Association for the Study of the Liver. […] The selection of patients who warrant surveillance for HCC is discussed separately.

• #4 Surveillance and Diagnosis of Hepatocellular Carcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2015/surveillance-and-diagnosis-of-hepatocellular-carcinoma/

  The goal of HCC surveillance is to detect disease early in its development in order to initiate potentially curative interventions and reduce overall morbidity, mortality, and the financial burden on the health care system. The 5-year survival rate of patients in whom HCC is diagnosed after the onset of symptoms is 0% to 10%. In contrast, when HCC is detected at an early stage, the 5-year survival rate is higher than 50%. […] The American Association for the Study of Liver Diseases (AASLD) recommends that patients who have cirrhosis and some patients who have chronic liver disease without cirrhosis undergo surveillance for HCC with ultrasonography (USG) every 6 months. […] The AASLD guidelines recommend that patients who have tumors smaller than 1 cm be monitored with a USG examination every 3 months. Tumors larger than 1 cm are investigated further with quadruple-phase, contrast-enhanced CT or MR imaging.

• #5 Surveillance and Diagnosis of Hepatocellular Carcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2015/surveillance-and-diagnosis-of-hepatocellular-carcinoma/

  The goal of HCC surveillance is to detect disease early in its development in order to initiate potentially curative interventions and reduce overall morbidity, mortality, and the financial burden on the health care system. The 5-year survival rate of patients in whom HCC is diagnosed after the onset of symptoms is 0% to 10%. In contrast, when HCC is detected at an early stage, the 5-year survival rate is higher than 50%. […] The American Association for the Study of Liver Diseases (AASLD) recommends that patients who have cirrhosis and some patients who have chronic liver disease without cirrhosis undergo surveillance for HCC with ultrasonography (USG) every 6 months. […] The AASLD guidelines recommend that patients who have tumors smaller than 1 cm be monitored with a USG examination every 3 months. Tumors larger than 1 cm are investigated further with quadruple-phase, contrast-enhanced CT or MR imaging.

• #6 Surveillance and Diagnosis of Hepatocellular Carcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2015/surveillance-and-diagnosis-of-hepatocellular-carcinoma/

  The goal of HCC surveillance is to detect disease early in its development in order to initiate potentially curative interventions and reduce overall morbidity, mortality, and the financial burden on the health care system. The 5-year survival rate of patients in whom HCC is diagnosed after the onset of symptoms is 0% to 10%. In contrast, when HCC is detected at an early stage, the 5-year survival rate is higher than 50%. […] The American Association for the Study of Liver Diseases (AASLD) recommends that patients who have cirrhosis and some patients who have chronic liver disease without cirrhosis undergo surveillance for HCC with ultrasonography (USG) every 6 months. […] The AASLD guidelines recommend that patients who have tumors smaller than 1 cm be monitored with a USG examination every 3 months. Tumors larger than 1 cm are investigated further with quadruple-phase, contrast-enhanced CT or MR imaging.

• #7 Hepatocellular Carcinoma (HCC) Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/197319-guidelines

  Guidelines for the screening, surveillance, diagnosis, and treatment of hepatocellular carcinoma (HCC) have been issued by the following organizations: American Association for the Study of Liver Diseases (AASLD), National Comprehensive Cancer Network (NCCN), American College of Gastroenterology (ACG), European Association for the Study of the Liver (EASL)European Organisation for Research and Treatment of Cancer (EORTC), European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), American Gastroenterological Association (AGA), International Stereotactic Radiosurgery Society. […] In its 2018 guidelines for the management of HCC, the AASLD recommends surveillance for HCC in adults with cirrhosis, because it improves overall survival. Surveillance should be conducted with ultrasonography (US), with or without alpha-fetoprotein (AFP) testing, every 6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) are not recommended as the primary modality for surveillance but may be used in select patients with a high likelihood of having an inadequate US or if US is attempted but inadequate.

• #8

  https://link.springer.com/article/10.1007/s00330-024-10606-w

  Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer related death worldwide. Current guidelines for the noninvasive diagnosis of HCC are provided by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD) which endorsed the Liver Imaging Reporting and Data System (LI-RADS) algorithm, the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC), and the Asian-Pacific Association for the Study of the Liver (APASL). These allow the diagnosis of HCC in high-risk patients in the presence of typical imaging features on contrast-enhanced CT, MRI, or contrast-enhanced ultrasound. Size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and growth are major imaging features and they should be combined for the diagnosis of HCC. This article provides concise and relevant practice recommendations aimed at general radiologist audience, summarizing the best practice and informing on the essential imaging criteria for the diagnosis of HCC, while also discussing the high-risk population criteria, imaging modalities, and imaging features according to the current guidelines.

• #9 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging, without biopsy confirmation. Even when biopsy is needed, imaging is usually required for guidance. […] Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk. Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months. […] AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage.

• #10 Hepatocellular carcinoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/369

  Hepatocellular carcinoma (HCC) usually arises in patients with liver cirrhosis due to any cause. […] A significant number of patients may be asymptomatic and are diagnosed following screening. […] Patients at risk of HCC should receive surveillance with an ultrasound of the liver and alpha fetoprotein at 6-month intervals. […] Treatment is guided by staging and prognosis. Treatment options include resection, transplantation, percutaneous ablation therapy, chemoembolization, and systemic immunotherapy. […] Atezolizumab plus bevacizumab, or durvalumab plus tremelimumab are the first-line agents for advanced-stage HCC. […] Key diagnostic factors include history of cirrhosis, history of chronic hepatitis B (HBV) or C (HCV), history of chronic heavy alcohol use, history of diabetes or obesity, family history of liver cancer, older age, and hepatomegaly.

• #11 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. […] Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy. […] On CT, HCC generally appears as a focal nodule with early enhancement on the arterial phase with rapid washout of contrast on the portal venous phase of a three-phase contrast scan. MRI of HCC generally demonstrates high signal intensity on T2 imaging. […] Biopsy is indicated in patients with HCCs that are larger than 2 cm with low AFP or in whom ablative treatment or transplant is contraindicated. In patients with elevated AFP and consistent imaging characteristics, patients can be treated presumptively for HCC without a biopsy.

• #12

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC. […] For early stage HCC screening, the European Association for the Study of the Liver (ECSL) and the American Association for the Study of Liver Diseases (AASLD) recommend an abdominal ultrasound (US) (with or without alpha-fetoprotein [AFP] monitoring) every 6 months in high-risk HCC patients with chronic liver disease or cirrhosis. However, the overall sensitivity of US to HCC is only 46%. On top of this, sensitivity for lesions smaller than 2 cm is only 21%, and it is substantially lower for lesions than 1 cm.

• #13 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  The focus of much research revolves around diagnostic strategies to identify early HCC, defined by size of tumor and number of lesions. Diagnostic tools commonly used include the serum tumor marker alfa-fetoprotein (AFP), radiographic imaging, and liver biopsy. […] The key to successful surveillance of HCC is defining the high-risk patient. […] AFP is a serum glycoprotein that was first recognized as a marker for HCC more than 40 years ago and has since been described to detect preclinical HCC. […] AFP has been shown to correlate with tumor size and volume at time of diagnosis. […] Monitoring AFP levels can be helpful in the diagnosis of recurrent disease, although this is largely restricted to patients with AFP-producing tumors. […] Imaging plays a key role in the diagnosis of HCC.

• #14 Clinical features and diagnosis of hepatocellular carcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-primary-hepatocellular-carcinoma

  Clinical features and diagnosis of hepatocellular carcinoma […] The diagnosis of HCC, which can be difficult, often requires the use of one or more imaging modalities. The goal is to detect the tumors when they are ≤2 cm in size so that the entire range of treatment options are available. […] This topic discusses the clinical and histologic features of HCC and methods for diagnosis. Our diagnostic approach is generally consistent with guidelines from the American Association for the Study of Liver Diseases (AASLD), the American College of Radiology’s Liver Imaging Reporting and Data System (LI-RADS), and the European Association for the Study of the Liver. […] The selection of patients who warrant surveillance for HCC is discussed separately.

• #15 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  Ultrasound (US) imaging has largely been replaced in diagnosis by CT scan and MRI as a diagnostic instrument of choice as a result of low sensitivity and positive predictive value with coexisting cirrhosis. […] CT evaluation of patients with suspected HCC should be done using multiphasic contrast imaging of the liver. […] MRI has become the diagnostic imaging mode of choice for HCC at many institutions worldwide. […] When performed at specialized centers, liver biopsy offers a safe and effective means to confirm suspicious lesions for HCC. […] Liver biopsy need not be performed under circumstances in which the diagnosis of HCC is certain after clinical, laboratory, and radiographic evaluation. […] The diagnosis of HCC poses many challenges which can vary among different regions and centers.

• #16

  https://www.xiahepublishing.com/2310-8819/JCTH-2024-00018

  Ultrasound is an essential technique for HCC surveillance. Abdominal ultrasonography is the preferred method for monitoring patients at high risk of HCC, including those with cirrhosis, and noncirrhotic patients with chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection or high HBV-DNA levels. A randomized controlled clinical trial including over 18,000 Chinese HCC patients found that ultrasound screening reduced the mortality risk by 37%. […] If liver nodules are detected, diagnosis and staging are necessary to guide subsequent treatment strategies. B-mode ultrasound serves as a reliable for imaging the macroscopic characteristics of HCC with distinct presentations varying by size on ultrasonography. In addition to CT and MRI, CEUS is a frequently utilized imaging modality for diagnosing liver cancer. All guidelines recommend the use of contrast-enhanced imaging when ultrasound has identified focal lesions larger than 1 cm. CEUS is a dynamic imaging technique that enables quantitative evaluation of microcirculation within tissues following the injection of a contrast agent.

• #17 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. […] Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy. […] On CT, HCC generally appears as a focal nodule with early enhancement on the arterial phase with rapid washout of contrast on the portal venous phase of a three-phase contrast scan. MRI of HCC generally demonstrates high signal intensity on T2 imaging. […] Biopsy is indicated in patients with HCCs that are larger than 2 cm with low AFP or in whom ablative treatment or transplant is contraindicated. In patients with elevated AFP and consistent imaging characteristics, patients can be treated presumptively for HCC without a biopsy.

• #18

  https://www.xiahepublishing.com/2310-8819/JCTH-2024-00018

  Ultrasound is an essential technique for HCC surveillance. Abdominal ultrasonography is the preferred method for monitoring patients at high risk of HCC, including those with cirrhosis, and noncirrhotic patients with chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection or high HBV-DNA levels. A randomized controlled clinical trial including over 18,000 Chinese HCC patients found that ultrasound screening reduced the mortality risk by 37%. […] If liver nodules are detected, diagnosis and staging are necessary to guide subsequent treatment strategies. B-mode ultrasound serves as a reliable for imaging the macroscopic characteristics of HCC with distinct presentations varying by size on ultrasonography. In addition to CT and MRI, CEUS is a frequently utilized imaging modality for diagnosing liver cancer. All guidelines recommend the use of contrast-enhanced imaging when ultrasound has identified focal lesions larger than 1 cm. CEUS is a dynamic imaging technique that enables quantitative evaluation of microcirculation within tissues following the injection of a contrast agent.

• #19

  https://www.xiahepublishing.com/2310-8819/JCTH-2024-00018

  The American College of Radiology launched the Liver Imaging Reporting and Data System (LI-RADS) for CEUS in 2016. This system utilizes SonoVue (Bracco Imaging SpA, Milan, Italy) as a contrast agent to classify hepatic nodules based on their size, pattern of arterial phase enhancement, type of clearance, and duration between enhancement and clearance. […] However, CEUS has some limitations. Firstly, inter-observer and intra-observer differences can always arise during the diagnosis of HCC using CEUS given the operator-dependent nature. Secondly, use of ultrasound is restricted in patients with severe obesity, air in the intestine, or heterogeneous cirrhosis. […] The primary dispute regarding CEUS is its limited universality in interpreting real-time imaging by different readers. The development of computer-aided diagnostic (CAD) systems and artificial intelligence (AI)-assisted identification has been proved to have remarkable capabilities to address this challenging issue. […] CEUS can assess the efficacy of these interventions by identifying alterations of tumor vascularization and detecting residual or recurrent tumors.

• #20 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  Ultrasound (US) imaging has largely been replaced in diagnosis by CT scan and MRI as a diagnostic instrument of choice as a result of low sensitivity and positive predictive value with coexisting cirrhosis. […] CT evaluation of patients with suspected HCC should be done using multiphasic contrast imaging of the liver. […] MRI has become the diagnostic imaging mode of choice for HCC at many institutions worldwide. […] When performed at specialized centers, liver biopsy offers a safe and effective means to confirm suspicious lesions for HCC. […] Liver biopsy need not be performed under circumstances in which the diagnosis of HCC is certain after clinical, laboratory, and radiographic evaluation. […] The diagnosis of HCC poses many challenges which can vary among different regions and centers.

• #21 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. […] Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy. […] On CT, HCC generally appears as a focal nodule with early enhancement on the arterial phase with rapid washout of contrast on the portal venous phase of a three-phase contrast scan. MRI of HCC generally demonstrates high signal intensity on T2 imaging. […] Biopsy is indicated in patients with HCCs that are larger than 2 cm with low AFP or in whom ablative treatment or transplant is contraindicated. In patients with elevated AFP and consistent imaging characteristics, patients can be treated presumptively for HCC without a biopsy.

• #22

• #23 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  Laboratory evaluation of patients with newly diagnosed HCC should include testing to determine the severity of the underlying liver disease. […] Laboratory results suggestive or indicative of disease severity include anemia, thrombocytopenia, hyponatremia, increased serum creatinine level, prolonged prothrombin time (PT)/INR, elevated liver enzymes, increased bilirubin level, and hypoglycemia. […] When elevated, the AFP is 75-91% specific, and values greater than 400 ng/mL are generally considered diagnostic of HCC in the proper clinical context, including appropriate radiologic findings. […] Accurate diagnosis and surgical planning require adequate cross-sectional imaging studies. […] Triple-phase CT has been found to be highly accurate in the diagnosis and characterization of HCCs but, like US, may miss smaller lesions.

• #24 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  Ultrasound (US) imaging has largely been replaced in diagnosis by CT scan and MRI as a diagnostic instrument of choice as a result of low sensitivity and positive predictive value with coexisting cirrhosis. […] CT evaluation of patients with suspected HCC should be done using multiphasic contrast imaging of the liver. […] MRI has become the diagnostic imaging mode of choice for HCC at many institutions worldwide. […] When performed at specialized centers, liver biopsy offers a safe and effective means to confirm suspicious lesions for HCC. […] Liver biopsy need not be performed under circumstances in which the diagnosis of HCC is certain after clinical, laboratory, and radiographic evaluation. […] The diagnosis of HCC poses many challenges which can vary among different regions and centers.

• #25 Hepatocellular Carcinoma: Diagnostic Work-Up

  https://www.onclive.com/view/hepatocellular-carcinoma-diagnostic-work-up

  Typically, for the majority of patients, the mainstay of diagnosis is going to be with dynamic multiphasic CT or MRI, preferably MR for purposes of sensitivity and specificity characteristics. […] We try to reserve doing a biopsy in, generally, under 10% of cases, if we see atypical features on the multiphasic imaging. […] There are still areas, both from the imaging standpoint, as well as tissue diagnosis, where we have some limitations in diagnosis. […] One of the things that we certainly hear about as a diagnostic tool for a lot of other oncologic diagnoses is PET [positron emission tomography] scan and we tend to order this less frequently or rely on this less commonly for a diagnosis of HCC [hepatocellular carcinoma]. […] Much of that has been based on the lower sensitivity for detecting HCC generally felt to be inadequate to consistently rely on that for purposes of sensitivity of diagnosis.

• #26 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #27 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. […] Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy. […] On CT, HCC generally appears as a focal nodule with early enhancement on the arterial phase with rapid washout of contrast on the portal venous phase of a three-phase contrast scan. MRI of HCC generally demonstrates high signal intensity on T2 imaging. […] Biopsy is indicated in patients with HCCs that are larger than 2 cm with low AFP or in whom ablative treatment or transplant is contraindicated. In patients with elevated AFP and consistent imaging characteristics, patients can be treated presumptively for HCC without a biopsy.

• #28

  https://link.springer.com/article/10.1007/s00330-024-10606-w

  HCC can be diagnosed noninvasively in the presence of typical imaging features on contrast-enhanced exams, including size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and growth. These criteria should be applied only in patients at high risk, with an elevated pre-test probability of having an HCC. Most of the guidelines are concordant that lesion size of at least 10 mm, non-rim arterial phase hyperenhancement, and non-peripheral washout are required to diagnose definitive HCC without needing histopathological confirmation. CECT and MRI with extracellular or hepatobiliary contrast agents are the recommended techniques for the diagnosis of HCC, and the choice of imaging exams and type of contrast agent should consider the availability, expertise, and patient characteristics. CEUS can be used as a problem-solving technique in atypical lesions or in patients with contraindications to CT/MRI contrast agents.

• #29 Hepatocellular Carcinoma: Diagnosis and Surveillance | IntechOpen

  https://www.intechopen.com/chapters/78406

  For all sizes and tumors with 1 cm MRI with extracellular contrast agents appears to be more sensitive than CT scan with comparable specificity and diagnostic odds. […] Hence for small lesions MRI with extracellular contrast agents may be preferred modality over CT scan. […] This technique uses Gadoxetic acid as a contrast agent. […] Addition of hepatobiliary phase to conventional dynamic MRI sequences increases likelihood of identifying malignant nodules and reduces the risk of overlooking malignant lesions. […] Contrast enhanced ultrasound and MRI with hepatobiliary contrast agents are promising modalities for evaluation of small and indeterminate nodules. […] Tumor markers play adjunct role in diagnosis but has prognostic significance. […] HCC diagnosis in cirrhotic liver is based on imaging criteria mentioned above.

• #30

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  The enhanced MRI of Gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), a liver-specific contrast agent, has been recommended by multiple guidelines as an effective method for detecting and characterizing liver lesions. […] The term „radiomics” was coined by Lambin et al, which aims to use „advanced feature analysis” to extract quantitative data from medical images and explore the correlation between research methodology and clinical outcomes. […] Radiomics analysis is conducive to the early diagnosis, differential diagnosis, and evaluation of MVI in HCC. […] At present, challenges in the diagnosis of early stage HCC and missed diagnosis of micrometastases remain the dominant factors for the poor prognosis of HCC.

• #31

  https://link.springer.com/article/10.1007/s00330-024-10606-w

  Noninvasive diagnosis of hepatocellular carcinoma (HCC) can be provided only in patients at high risk. […] Contrast-enhanced CT or MRI are the first-line imaging exams for the diagnosis of HCC. […] Major imaging features should be combined to provide the diagnosis of definitive HCC. […] Noninvasive diagnostic criteria for the diagnosis of HCC can be applied only in patients with high risk factors in order to maintain a high specificity for the HCC diagnosis. […] The key imaging criteria for the diagnosis of HCC are size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and threshold growth (level of evidence: high). […] The diagnosis of HCC can be obtained noninvasively without the need of histopathological confirmation in presence of typical imaging features on contrast-enhanced CT (CECT), MRI, or contrast-enhanced ultrasound (CEUS) in patients at high risk.

• #32

  https://link.springer.com/article/10.1007/s00330-024-10606-w

  Noninvasive diagnosis of hepatocellular carcinoma (HCC) can be provided only in patients at high risk. […] Contrast-enhanced CT or MRI are the first-line imaging exams for the diagnosis of HCC. […] Major imaging features should be combined to provide the diagnosis of definitive HCC. […] Noninvasive diagnostic criteria for the diagnosis of HCC can be applied only in patients with high risk factors in order to maintain a high specificity for the HCC diagnosis. […] The key imaging criteria for the diagnosis of HCC are size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and threshold growth (level of evidence: high). […] The diagnosis of HCC can be obtained noninvasively without the need of histopathological confirmation in presence of typical imaging features on contrast-enhanced CT (CECT), MRI, or contrast-enhanced ultrasound (CEUS) in patients at high risk.

• #33

  https://link.springer.com/article/10.1007/s00330-024-10606-w

  HCC can be diagnosed noninvasively in the presence of typical imaging features on contrast-enhanced exams, including size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and growth. These criteria should be applied only in patients at high risk, with an elevated pre-test probability of having an HCC. Most of the guidelines are concordant that lesion size of at least 10 mm, non-rim arterial phase hyperenhancement, and non-peripheral washout are required to diagnose definitive HCC without needing histopathological confirmation. CECT and MRI with extracellular or hepatobiliary contrast agents are the recommended techniques for the diagnosis of HCC, and the choice of imaging exams and type of contrast agent should consider the availability, expertise, and patient characteristics. CEUS can be used as a problem-solving technique in atypical lesions or in patients with contraindications to CT/MRI contrast agents.

• #34 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  Hepatocellular carcinoma (HCC) is the leading cause of primary liver cancers. Surveillance of individuals at specific risk of developing HCC, early diagnostic markers, and new therapeutic approaches are essential to obtain a reduction in disease-related mortality. […] In the last decades imaging technologies, statistical models, and standardized diagnostic procedures associated with clinical guidelines for intervention significantly enhanced the success rate and life expectancy of HCC patients. […] Imaging technology advances have enhanced the diagnostic power of multiphasic computed tomography (CT) scan, dynamic contrast-enhanced magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) scan. […] The American College of Radiology has developed the Liver Imaging Reporting and Data System (LI-RADS), which is a comprehensive system for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging.

• #35 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  According to LI-RADS, diagnostic hallmarks of HCC include arterial phase hyperenhancement, non-peripheral venous or delayed phase washout appearance, enhancing capsule appearance, and threshold growth. […] Once the diagnosis is established, prognostic assessment is a critical step in the clinical decision making of HCC management, evaluating not only tumor stage but also liver function and performance status. […] The current European Association for the Study of the Liver Clinical Practice Guidelines endorse the Barcelona Clinic Liver Cancer (BCLC) staging system. […] Hepatic resection may be a potentially curative therapy for patients with good performance status, preserved liver function, and solitary tumor of any size with no evidence of gross vascular invasion. […] However, tumor recurrence can be observed in 50-70% of cases within 5 years following surgery, either as intrahepatic metastases or as new HCC in the remaining cirrhotic liver.

• #36 SciELO Brazil – BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA

  https://www.scielo.br/j/ag/a/jnWVcf9QdnNQNgsYQ8KxjBk/

  Accurate diagnosis of HCC is critical for determining curative treatment. Multiphase CT and MRI studies are the main radiological exams used. […] The presence of the typical pattern on CT and MRI of arterial hyperenhancement and washout on portal venous or delayed phase have sensitivity between 66% and 82% and specificity above 90% for the diagnosis of HCC in patients with cirrhosis and nodules larger than 1 cm in diameter. […] The diagnosis of HCC in cirrhotic patients can be made by noninvasive methods and/or biopsy. […] Multiphase CT or MRI studies are the basis for the diagnosis of HCC in the high-risk population. […] Nodules larger than 1 cm detected on ultrasound in cirrhotic patients require further CT or MRI investigation. […] If radiological findings are not typical or the enhancement pattern is atypical, a second dynamic imaging study (using another imaging modality) or lesion biopsy should be performed.

• #37 Diagnosis of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023919/

  The focus of much research revolves around diagnostic strategies to identify early HCC, defined by size of tumor and number of lesions. Diagnostic tools commonly used include the serum tumor marker alfa-fetoprotein (AFP), radiographic imaging, and liver biopsy. […] The key to successful surveillance of HCC is defining the high-risk patient. […] AFP is a serum glycoprotein that was first recognized as a marker for HCC more than 40 years ago and has since been described to detect preclinical HCC. […] AFP has been shown to correlate with tumor size and volume at time of diagnosis. […] Monitoring AFP levels can be helpful in the diagnosis of recurrent disease, although this is largely restricted to patients with AFP-producing tumors. […] Imaging plays a key role in the diagnosis of HCC.

• #38 Guide for diagnosis and treatment of hepatocellular carcinoma

  https://www.wjgnet.com/1948-5182/full/v7/i12/1632.htm

  To date, the surveillance for hepatic focal lesions in high risk patients is based on US. […] The diagnostic accuracy assessed by the sensitivity and specificity of these different radiological modalities in HCC detection was shown in Table 1. […] The most frequently used marker for diagnosis of HCC is the serum concentration level of AFP. […] The utility of AFP in differentiating HCC from benign liver diseases has also been noted to be limited with false negative rates and high false positive rates. […] It should only be considered when diagnostic imaging results are doubtful, for example, in patients with cirrhosis and nodules of hypovascular nature, and the result would directly have an impact on management. […] At present, the surveillance of HCC is based on US examination every 6 mo because AFP lacks the satisfactory sensitivity and specificity necessary for successful surveillance and diagnosis.

• #39 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging, without biopsy confirmation. Even when biopsy is needed, imaging is usually required for guidance. […] Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk. Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months. […] AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage.

• #40 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging, without biopsy confirmation. Even when biopsy is needed, imaging is usually required for guidance. […] Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk. Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months. […] AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage.

• #41 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging, without biopsy confirmation. Even when biopsy is needed, imaging is usually required for guidance. […] Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk. Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months. […] AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage.

• #42 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  The diagnosis of hepatocellular carcinoma (HCC) can often be established on the basis of noninvasive imaging, without biopsy confirmation. Even when biopsy is needed, imaging is usually required for guidance. […] Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk. Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months. […] AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage.

• #43

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  Therefore, based on the concept of precision medicine, the development of novel laboratory and imaging diagnoses is a key strategy for improving the early diagnosis of HCC. […] New discoveries have recently been made to gain a deeper understanding of the intricate signaling regulatory network in HCC, and the diagnostic relevance of these molecular markers and metabolites in HCC has been continuously validated, which can be used in conjunction with traditional pathology to further improve the accuracy of HCC diagnosis. […] In recent years, numerous novel serum biomarkers have been studied, including lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), des-gamma-carboxy prothrombin (DCP), Golgi protein 73 (GP73), Glypican-3 (GPC3), and so on. When detected alone or in combination, along with related scores, they have tremendous potential for the diagnosis of early stage HCC.

• #44

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  The quantitative detection method of AFP commonly used in clinics is the sum of AFP-L1, AFP-L2, and AFP-L3 heteroplasms. […] Studies have previously reported that AFP-L3 has superior diagnostic sensitivity in the early diagnosis of HCC compared to total AFP. […] DCP is also known as prothrombin induced by vitamin K absence II (PIVKA II). […] Some studies have established that DCP is more accurate than AFP in the diagnosis of HCC in patients with LC, with a sensitivity and specificity of 74% and 92%, respectively. […] GPC3 can be used as a biomarker for the diagnosis of ANHC and early HCC. […] GP73, combined with other serum markers, has a high diagnostic value of HCC. […] In recent years, studies on emerging serum markers ways have prompted efforts to transform valuable biomarkers into clinical models and form a unified standard.

• #45 Serum Tumor Markers for Early Diagnosis of Primary Hepatocellular Carc | JHC

  https://www.dovepress.com/serum-tumor-markers-for-early-diagnosis-of-primary-hepatocellular-carc-peer-reviewed-fulltext-article-JHC

  High false negative rates (30% in advanced HCC and 40% in early stage HCC). Therefore, extra biomarkers are needed to supplement AFP in order to improve the accuracy of HCC diagnosis. Joint detection of multiple markers can make up for the deficiency of AFP detection. […] GP73 has been demonstrated to be an ideal serum marker in the early diagnosis of HCC and assessment of postoperative recurrence. Its specificity and sensitivity are both superior compared to AFP. […] GP73 may be related to the progress and metastasis of HCC and can thus be used as a new serum marker to monitor the recurrence of primary HCC, help clinicians determine treatment time, and improve patient prognosis and survival. […] The study showed that the APT level in patients with hepatic carcinoma is significantly higher than that in normal people and there is no significant difference between patients with liver cirrhosis, chronic hepatitis, and some other malignant tumors.

• #46 Serum Tumor Markers for Early Diagnosis of Primary Hepatocellular Carc | JHC

  https://www.dovepress.com/serum-tumor-markers-for-early-diagnosis-of-primary-hepatocellular-carc-peer-reviewed-fulltext-article-JHC

  Therefore, APT may be superior to AFP for hepatic carcinoma monitoring, early diagnosis, treatment response, and recurrence monitoring. The combination of APT and AFP will provide a more reliable basis for monitoring, treatment, and follow-up monitoring of hepatic carcinoma. […] OPN is a promising diagnostic biomarker of HCC. When OPN is combined with AFP and other biomarkers, the detection rate of HCC increases, heightening both sensitivity and specificity. […] DKK1 serological level can be used as a sensitive and noninvasive test for early diagnosis and prognosis of HCC. This testing method can make up for the deficiency of existing serological diagnosis, but further long-term follow-up study is needed to clarify the diagnostic and prognostic value of serum DKK1 in HCC patients. […] Although some studies have reported serum tumor markers with potential value for hepatic carcinoma, many problems associated with the research on these tumor markers exist: 1. relevant research studies have small sample sizes, are single-center, lack large-scale and multi-center sample data support, and have not had effective follow-up for clinical verification; therefore, large sample sizes and multi-center data are needed to be performed.

• #47 Hepatocellular Carcinoma Panel | Test Detail | Quest Diagnostics

  https://testdirectory.questdiagnostics.com/test/test-detail/16222/hepatocellular-carcinoma-panel?p=r&cc=MASTER

  Hepatocellular Carcinoma Panel – HCC Risk Panel includes serum AFP-L3%, total AFP and DCP. The combined measurement helps discriminate benign and malignant conditions related to primary liver diseases. Furthermore, the combination measurement of three HCC biomarkers can identify a greater number of patients at risk of developing HCC than with each marker alone. […] Includes Alpha-Fetoprotein (AFP), AFP-L3, DCP (Des-Gamma-Carboxy-Prothrombin). […] Methodology: Liquid-Phase Binding Assay System • Immunoassay (IA). […] Reference Range(s): AFP 1.6-4.5 ng/mL, AFP-L3 0.5-9.9 %, DCP <7.5 ng/mL. [...] Preferred Specimen(s): 2 mL serum. [...] Minimum Volume: 1 mL. [...] Transport Temperature: Frozen. [...] Specimen Stability: Room temperature: 48 hours, Refrigerated: 5 days, Frozen: 21 days. [...] Reject Criteria: Hemolysis • Lipemia • Heavy, visible particulate matter • Icteric.

• #48 Hepatocellular Carcinoma Panel | Test Detail | Quest Diagnostics

  https://testdirectory.questdiagnostics.com/test/test-detail/16222/hepatocellular-carcinoma-panel?p=r&cc=MASTER

  Hepatocellular Carcinoma Panel – HCC Risk Panel includes serum AFP-L3%, total AFP and DCP. The combined measurement helps discriminate benign and malignant conditions related to primary liver diseases. Furthermore, the combination measurement of three HCC biomarkers can identify a greater number of patients at risk of developing HCC than with each marker alone. […] Includes Alpha-Fetoprotein (AFP), AFP-L3, DCP (Des-Gamma-Carboxy-Prothrombin). […] Methodology: Liquid-Phase Binding Assay System • Immunoassay (IA). […] Reference Range(s): AFP 1.6-4.5 ng/mL, AFP-L3 0.5-9.9 %, DCP <7.5 ng/mL. [...] Preferred Specimen(s): 2 mL serum. [...] Minimum Volume: 1 mL. [...] Transport Temperature: Frozen. [...] Specimen Stability: Room temperature: 48 hours, Refrigerated: 5 days, Frozen: 21 days. [...] Reject Criteria: Hemolysis • Lipemia • Heavy, visible particulate matter • Icteric.

• #49 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  Thus, the diagnostic work-up has been primarily targeted to assess tumor morphologic features such as nodules number, max diameter, presence of satellite nodules or macrovascular invasion, rather than precise biologic behaviour. […] As a matter of fact, liver biopsy is not routinely performed, and its indication is restricted to cases of nodules highly suspicious for malignancy but not completely meeting imaging criteria for HCC, or of non-cirrhotic patients with suspected HCC lesions. […] A significant limitation in the HCC treatment is the absence of early diagnostic markers. […] To overcome the problem, over the years, several laboratories have investigated molecules with a potential diagnostic impact as well as a possible therapeutic output when targeted. […] Comprehensively, what emerges in literature is an increasing interest in the identification of biomarkers for both prognosis and therapy.

• #50 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. […] Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy. […] On CT, HCC generally appears as a focal nodule with early enhancement on the arterial phase with rapid washout of contrast on the portal venous phase of a three-phase contrast scan. MRI of HCC generally demonstrates high signal intensity on T2 imaging. […] Biopsy is indicated in patients with HCCs that are larger than 2 cm with low AFP or in whom ablative treatment or transplant is contraindicated. In patients with elevated AFP and consistent imaging characteristics, patients can be treated presumptively for HCC without a biopsy.

• #51 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #52 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #53 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #54 Hepatocellular Carcinoma (HCC) Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/197319-guidelines

  The AASLD guidelines include the following recommendations regarding biopsy: If the diagnosis of HCC cannot be established from routine histology, staining for several biomarkers, including the diagnostic panel of glypican-3 (GPC3), heat shock protein 70 (HSP70), and glutamine synthetase, can be used to help distinguish HCC from high-grade dysplastic nodules. […] The 2018 ESMO guidelines contain the following recommendations regarding diagnosis of HCC: The diagnosis of HCC is based on histological analysis and/or contrast-enhanced imaging findings. The diagnosis can be established if the typical vascular hallmarks of HCC (hypervascularity in the arterial phase with washout in the portal venous or delayed phase) are identified in a nodule of 1cm diameter using one of those two modalities in a cirrhotic patient. […] Further immunohistochemical markers have been shown to improve the diagnosis of highly differentiated HCC, including glutamine synthetase, GPC3, circulating tumor cells (CTC), EZH2, and HSP70.

• #55 Diagnosis of Hepatocellular Carcinoma | IntechOpen

  https://www.intechopen.com/chapters/52230

  The diagnostic approach to the solid liver lesion is commonly determined by the size of the lesion. […] The American Association for the Study of Liver Diseases (ASLD) and Korean Liver Cancer study Group-National Cancer Centre Korea (KLCSG-NCC) guidelines recommend follow-up ultrasound (US) every three-six months if the lesions are lesser than 1 cm and require definitive contrast-enhanced imaging with either 4-phase computed tomography (CT) or magnetic resonance imaging (MRI) if the lesions are larger than 1 cm; otherwise European Association for the Study of the Liver (EASL) guidelines have different algorithm which had three ways; first one is which nodules are lesser than 1 cm, second one is in diameter 12 cm, and third one is larger than 2 cm. […] Histologic confirmation is not required in a patient at increased risk of hepatocellular carcinoma whose lesion(s) fulfill criteria for hepatocellular carcinoma which are the presence of typical features on 4-phase CT or MRI, including hypervascularity during arterial phase followed by decreased enhancement (washout) during portal venous phases on CT or has increased T2 signal intensity on MRI.

• #56 Hepatocellular Carcinoma (HCC) Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/197319-guidelines

  The AASLD recommendations for follow-up of abnormal screening results include the following: For nodules identified on US that are 1 cm, repeat US at intervals of 3-6 months; if no growth is observed over a period of up to 2 years, revert to routine surveillance. A lesion of 10 mm on ultrasound or an AFP level 20 ng/mL should trigger recall procedures for the diagnosis of HCC. […] Noninvasive diagnosis of HCC requires multiphase imaging evaluated using stringent criteria. The American College of Radiology has published guidelines on the performance interpretation, and reporting of multiphase CT and MR exams through its CT/MRI Liver Imaging Reporting And Data System (CT/MRI LI-RADS). […] If these criteria are not present but HCC or other malignancy is considered probable, then a liver biopsy should be considered for diagnosis. In patients without cirrhosis, the diagnosis of HCC cannot be made by imaging, even if the scan shows hypervascularity in the arterial phase with washout in the portal venous or delayed phase; biopsy is required in these cases.

• #57 Surveillance and Diagnosis of Hepatocellular Carcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2015/surveillance-and-diagnosis-of-hepatocellular-carcinoma/

  The goal of HCC surveillance is to detect disease early in its development in order to initiate potentially curative interventions and reduce overall morbidity, mortality, and the financial burden on the health care system. The 5-year survival rate of patients in whom HCC is diagnosed after the onset of symptoms is 0% to 10%. In contrast, when HCC is detected at an early stage, the 5-year survival rate is higher than 50%. […] The American Association for the Study of Liver Diseases (AASLD) recommends that patients who have cirrhosis and some patients who have chronic liver disease without cirrhosis undergo surveillance for HCC with ultrasonography (USG) every 6 months. […] The AASLD guidelines recommend that patients who have tumors smaller than 1 cm be monitored with a USG examination every 3 months. Tumors larger than 1 cm are investigated further with quadruple-phase, contrast-enhanced CT or MR imaging.

• #58 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #59 Diagnosis and treatment of hepatocellular carcinoma. Update of the consensus document of the AEEH, AEC, SEOM, SERAM, SERVEI, and SETH | Medicina Clínica (English Edition)

  https://www.elsevier.es/en-revista-medicina-clinica-english-edition–462-articulo-diagnosis-treatment-hepatocellular-carcinoma-update-S2387020621001765

  In patients with liver cirrhosis, the probability that a new nodule detected by ultrasound is an HCC is very high, especially if its diameter exceeds 10mm. […] Nodules larger than or equal to 1cm detected by ultrasound in cirrhotic patients can be diagnosed as HCC without the need for histological confirmation if they present contrast enhancement in the arterial phase followed by washout in venous phases in an imaging technique (MDCT or extracellular contrast MRI). […] The determination of AFP is not useful for the diagnosis of HCC.

• #60

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  In recent years, liquid biopsy has become a research hotspot for the diagnosis of HCC. […] The combination of cfDNA and AFP can further distinguish between HCC and non-HCC patients, with a sensitivity of 95.1% and a specificity of 94.4%. […] The molecular diagnosis of HCC specifically involves using high-throughput sequencing techniques, such as whole-genome sequencing, exome sequencing, and single-cell sequencing, to type HCC at the molecular level. […] When imaging and routine tissue microscopic examination are unable to reach a diagnosis, FNA-based molecular approaches can diagnose HCC with minimal invasion, representing one of the future directions for the development of precision medicine in the differential diagnosis of HCC. […] The application of contrast media can improve diagnostic efficiency.

• #61

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  In recent years, liquid biopsy has become a research hotspot for the diagnosis of HCC. […] The combination of cfDNA and AFP can further distinguish between HCC and non-HCC patients, with a sensitivity of 95.1% and a specificity of 94.4%. […] The molecular diagnosis of HCC specifically involves using high-throughput sequencing techniques, such as whole-genome sequencing, exome sequencing, and single-cell sequencing, to type HCC at the molecular level. […] When imaging and routine tissue microscopic examination are unable to reach a diagnosis, FNA-based molecular approaches can diagnose HCC with minimal invasion, representing one of the future directions for the development of precision medicine in the differential diagnosis of HCC. […] The application of contrast media can improve diagnostic efficiency.

• #62

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  In recent years, liquid biopsy has become a research hotspot for the diagnosis of HCC. […] The combination of cfDNA and AFP can further distinguish between HCC and non-HCC patients, with a sensitivity of 95.1% and a specificity of 94.4%. […] The molecular diagnosis of HCC specifically involves using high-throughput sequencing techniques, such as whole-genome sequencing, exome sequencing, and single-cell sequencing, to type HCC at the molecular level. […] When imaging and routine tissue microscopic examination are unable to reach a diagnosis, FNA-based molecular approaches can diagnose HCC with minimal invasion, representing one of the future directions for the development of precision medicine in the differential diagnosis of HCC. […] The application of contrast media can improve diagnostic efficiency.

• #63

  https://journals.lww.com/cmj/fulltext/2023/05200/precision_diagnosis_of_hepatocellular_carcinoma.3.aspx

  The enhanced MRI of Gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), a liver-specific contrast agent, has been recommended by multiple guidelines as an effective method for detecting and characterizing liver lesions. […] The term „radiomics” was coined by Lambin et al, which aims to use „advanced feature analysis” to extract quantitative data from medical images and explore the correlation between research methodology and clinical outcomes. […] Radiomics analysis is conducive to the early diagnosis, differential diagnosis, and evaluation of MVI in HCC. […] At present, challenges in the diagnosis of early stage HCC and missed diagnosis of micrometastases remain the dominant factors for the poor prognosis of HCC.

• #64 Latest advances in hepatocellular carcinoma management and prevention through advanced technologies | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-023-00306-3

  Artificial intelligence (AI) algorithms for HCC diagnosis have also gained attention. An AI algorithm based on radiomics features has been shown to improve the accuracy of HCC diagnosis compared to traditional imaging methods. […] Recent advances in these areas have improved HCC management. […] Early detection of hepatocellular carcinoma (HCC) is crucial for improving patient outcomes. […] Several biomarkers, including alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and glypican-3 (GPC3), have been investigated for their potential as diagnostic and prognostic markers for HCC. […] The development of targeted medicine and bioengineering has significantly advanced personalized treatment for hepatocellular carcinoma. […] Several screening modalities have been investigated for HCC, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and serum biomarkers such as alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP).

• #65 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  According to LI-RADS, diagnostic hallmarks of HCC include arterial phase hyperenhancement, non-peripheral venous or delayed phase washout appearance, enhancing capsule appearance, and threshold growth. […] Once the diagnosis is established, prognostic assessment is a critical step in the clinical decision making of HCC management, evaluating not only tumor stage but also liver function and performance status. […] The current European Association for the Study of the Liver Clinical Practice Guidelines endorse the Barcelona Clinic Liver Cancer (BCLC) staging system. […] Hepatic resection may be a potentially curative therapy for patients with good performance status, preserved liver function, and solitary tumor of any size with no evidence of gross vascular invasion. […] However, tumor recurrence can be observed in 50-70% of cases within 5 years following surgery, either as intrahepatic metastases or as new HCC in the remaining cirrhotic liver.

• #66 Hepatocellular Carcinoma (HCC): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21709-hepatocellular-carcinoma-hcc

  Hepatocellular carcinoma (HCC) is cancer in your liver. […] If youre at high risk for HCC, you should see your provider regularly to check for signs of HCC. […] Given how serious it is, you should receive regular checks for signs of HCC if you have cirrhosis or MASLD. […] If you belong to a high-risk group, your healthcare provider may suggest regular screenings to catch HCC early, when its treatable. […] Your healthcare provider will do a physical exam. Theyll also ask about your medical history, symptoms and lifestyle. […] Tests to help confirm a diagnosis include: […] HCC is an unusual cancer because in people with cirrhosis, providers can make the diagnosis based on the tumor(s) having certain features on an MRI or CT scan without needing to do a biopsy. […] Cancer staging for HCC allows your healthcare provider to determine how advanced it is. It also helps them plan treatments and determine your prognosis (outlook). […] Treatments include: […] Your healthcare provider may suggest participating in a clinical trial to try new HCC treatments. […] Catching HCC early, when surgery can treat it, delivers the best possible outcomes.

• #67 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  According to LI-RADS, diagnostic hallmarks of HCC include arterial phase hyperenhancement, non-peripheral venous or delayed phase washout appearance, enhancing capsule appearance, and threshold growth. […] Once the diagnosis is established, prognostic assessment is a critical step in the clinical decision making of HCC management, evaluating not only tumor stage but also liver function and performance status. […] The current European Association for the Study of the Liver Clinical Practice Guidelines endorse the Barcelona Clinic Liver Cancer (BCLC) staging system. […] Hepatic resection may be a potentially curative therapy for patients with good performance status, preserved liver function, and solitary tumor of any size with no evidence of gross vascular invasion. […] However, tumor recurrence can be observed in 50-70% of cases within 5 years following surgery, either as intrahepatic metastases or as new HCC in the remaining cirrhotic liver.

• #68 Liver Cancer – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/liver-cancer/

  Hepatocellular carcinoma often displays characteristic patterns on CT or MRI: An enhancement in the early arterial phase, followed by washout in the delayed phase, which generates an enhanced rim of enhancement surrounding the lesion (capsule) that is highly specific for liver cancer. […] Several systems can facilitate staging of hepatocellular carcinoma. The widely used Barcelona Clinic Liver Cancer staging system incorporates a combination of tumor burden, liver function, patient physical health status, AFP value, ALBI score, ChildPugh score, and MELD score to allow categorization of hepatocellular carcinoma into 5 stages. […] Hepatocellular carcinoma needs to be distinguished from other conditions or tumors that may present with similar symptoms. […] Treatments for liver cancer can be categorized as curative or noncurative.

• #69 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #70 Hepatocellular Carcinoma (HCC) Workup: Approach Considerations, Laboratory Studies, Ultrasonography

  https://emedicine.medscape.com/article/197319-workup

  MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. […] The decision to biopsy a lesion suspected of being hepatocellular carcinoma is the subject of ongoing controversy. […] In patients with lesions smaller than 1 cm, fewer than 50% of the lesions will be malignant, and the false-negative result rate is high. […] In patients with 1- to 2-cm lesions, a biopsy should be performed; these patients have a significant risk of malignancy. […] Patients with lesions larger than 2 cm, cirrhosis, characteristic imaging studies, and elevated AFP values can be managed without biopsy. […] Histology is quite variable: tumors range from well differentiated to anaplastic. […] The prognosis in patients with HCC reflects both tumor characteristics (ie, size, location, tumor biology) and the degree of underlying liver disease. […] The Barcelona Clinic Liver Cancer (BCLC) system is very useful in deciding among potential treatment options and correlates best with patient outcome among the major staging systems.

• #71 Guide for diagnosis and treatment of hepatocellular carcinoma

  https://www.wjgnet.com/1948-5182/full/v7/i12/1632.htm

  Hepatocellular carcinoma (HCC) is ranked as the 5th common type of cancer worldwide and is considered as the 3rd common reason for cancer-related deaths. […] The prognosis of HCC is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Recent studies revealed poor sensitivity and specificity of alpha-fetoprotein (AFP) for proper surveillance and diagnosis. Thus, the basis for surveillance is still an abdominal ultrasound (US) every 6 mo despite inadequate sensitivity. […] A multidisciplinary approach includes clinical, radiological, and laboratory modalities with or without liver biopsy (in certain cases) to establish the diagnosis of HCC. […] Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography, iodised oil-CT, and CT arterial portography in addition to the conventional hepatic angiography.

• #72 Hepatocellular Carcinoma: Diagnosis and Surveillance | IntechOpen

  https://www.intechopen.com/chapters/78406

  Hepatocellular carcinoma arises commonly on the background of liver cirrhosis. […] Diagnosis of hepatocellular carcinoma is commonly performed by multiphase computed tomography (CT) and / or magnetic resonance imaging scans (MRI). […] For HCC in cirrhotic liver biopsy is seldom required and diagnosis is based on typical imaging features of non-rim arterial phase hyperenhancement and washout on delayed phase and pseudocapsule appearance. […] This chapter focuses on diagnosis and surveillance for HCC. […] Diagnosis of hepatocellular carcinoma is primarily based on imaging with multiphase computed tomography (CT) scan and/or multiphase magnetic resonance imaging (MRI) scan. […] HCC usually becomes symptomatic only in advanced stages of the disease hence clinical features are seldom useful for the diagnosis of disease.

• #73 Hepatocellular Carcinoma: Diagnosis and Surveillance | IntechOpen

  https://www.intechopen.com/chapters/78406

  However biopsy is required in patients with vascular liver diseases, non-cirrhotic livers, inconclusive radiological investigations, elevation of CA 19.9 or carcinoembryonic antigen (CEA) and liver lesion without HCC risk factors. […] Diagnosis of HCC requires multiphase computed tomography or MRI scan. […] In cirrhotic liver, diagnosis of HCC is based on typical imaging features and rarely needs biopsy. […] HCC surveillance in high risk groups with biannual ultrasound with or without alfa-fetoprotein helps in early detection of lesions which are amenable to curative treatment. […] Multidisciplinary teams provide platform for care coordination, reassessments of clinical course, and fine changes in treatment plans required for this complex group of patients.

• #74 Hepatocellular Carcinoma: Diagnosis, Therapy and Molecular Investigations

  https://www.scientificarchives.com/article/hepatocellular-carcinoma-diagnosis-therapy-and-molecular-investigations

  Identification of early diagnostic markers able to prevent the development of HCC will lead to the consequent possibility to immediately target the tumor, limiting its development. […] Despite its promising possibilities, however, a therapeutic strategy based on the identification of effective biomarkers for HCC will be complex and will require a deep investigation of many mechanisms before treatment planning can start. […] In conclusion, although in recent years standardized diagnostic protocols and therapeutic procedures associated with new pharmacological approaches have enhanced the success rate extending the life expectancy of HCC patients, HCC remains one of the most prevalent neoplasia worldwide. Further studies are needed to discover reliable and easily accessible early diagnostic markers as well as new and more effective therapies.

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