Materiały źródłowe

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

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

  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.

• #1 Diagnosing Liver Cancer | American Cancer Society | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/how-diagnosed.html

  Your doctor could order blood tests for a number of reasons: To help diagnose liver cancer (although the diagnosis can’t be made on a blood test alone), To help determine what might have caused your liver cancer, To learn how well your liver is working, which can affect what treatments you can have, To see how well treatment is working, To look for signs that the cancer has come back after treatment. […] AFP is a protein that can sometimes be found at high levels in the blood of people with liver cancer. If AFP levels are very high in someone with a liver tumor, it can be a sign that liver cancer is present. […] This test can be used to look for possible signs that the cancer has come back (recurred).

• #1 Advancements in the Diagnosis of Hepatocellular Carcinoma

  https://www.mdpi.com/2673-8937/3/1/5

  Common screening options for HCC include abdominal ultrasounds and alpha-fetoprotein (AFP) biomarker testing. Abdominal ultrasound is the preferred imaging modality over computed tomography (CT) and magnetic resonance imaging (MRI) due to the inexpensive cost and widespread availability. The sensitivity of abdominal ultrasound for early HCC detection is around 45%. Additional screening with AFP biomarker testing may improve HCC detection rates. AFP is a serum glycoprotein and elevations are associated with liver malignancy. AFP levels greater than 400–500 ng/mL are diagnostic for HCC. The sensitivity of HCC detection with a combination approach is around 63%, however, ultrasound with concurrent AFP testing has a lower specificity than ultrasound alone. […] Current standards for diagnostic modalities for hepatocellular carcinoma include imaging with CT, MRI, and ultrasound, as well as tissue biopsy, which has been strongly recommended before transplantation with uncertain imaging. The specificity and positive predictive value of tumor biopsy is 100%, but the sensitivity may vary between 66% to 93%, depending on the size of the needle and nodule, thus making ruling out diagnosis less reliable with biopsy. Patients with negative biopsy findings should undergo surveillance via imaging. Imaging is a non-invasive option compared to traditional tissue biopsy, and MRI is the gold standard for imaging of HCC due to its diagnostic accuracy and significantly higher sensitivity, as well as significantly lower negative likelihood ratio as compared to CT.

• #1 Liver Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,BLivD1

  Liver function tests (LFTs) […] These tests can show liver irritation and inflammation. They can’t tell for sure if you have liver cancer. But if the tests show liver damage, your healthcare provider will likely do other tests to look for the cause of the damage. The damage could be from many different things, like cirrhosis, hepatitis, or cancer. […] Imaging tests may also be done to look for liver cancer. […] Ultrasound […] This is often the first test done if your healthcare provider suspects liver cancer. An ultrasound is easy to do and doesn’t use radiation. It’s very good at showing whether a liver tumor is a fluid-filled sac (cyst) that’s likely not cancer, or a solid mass that’s more likely to be cancer. An ultrasound uses sound waves to look for changes in the liver. The sound waves bounce off your insides and send back a series of signals. A computer turns these signals into images.

• #1 Diagnosis of liver cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/liver/diagnosis

  If doctors think someone has liver cancer, they will order a blood test to check for hepatitis viruses. Chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV) or both increases the risk of developing liver cancer. […] Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose liver cancer.

• #1 Biomarkers for diagnosis and therapeutic options in hepatocellular carcinoma | Molecular Cancer | Full Text

  https://molecular-cancer.biomedcentral.com/articles/10.1186/s12943-024-02101-z

  Some notable recent clinical trials working on targeted therapies are also highlighted. […] HCC can often be diagnosed using non-invasive imaging, like computer tomography (CT) / magnetic resonance imaging (MRI), due to its characteristic radiographic features, such as arterial hyperenhancement, venous washout, and capsule enhancement. […] The Liver Imaging Reporting and Data System (LI-RADS) is an established scoring system for HCC diagnosis among HBV-infected and cirrhotic patients, with a 67% sensitivity and 93% specificity for detecting tumor nodules larger than 1 cm in diameter. […] However, a biopsy is still necessary for patients with LR-4 or above observations without known risk factors for HCC or those with atypical imaging findings. […] The utilization of biomarkers, such as AFP, prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II), and glypican-3 (GPC3), has shown promise in improving the early detection of HCC.

• #1 Diagnosing Liver Cancer | American Cancer Society | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/how-diagnosed.html

  Sometimes a diagnosis of liver cancer can be made based on the way a liver tumor looks on CEUS, without the need for a biopsy. […] Sometimes a diagnosis of liver cancer can be made based on the way a liver tumor looks on a CT scan, without the need for a biopsy. […] Sometimes a diagnosis of liver cancer can be made based on the way a liver tumor looks on an MRI, without a biopsy. […] A biopsy is the removal of a sample of tissue to see if it is cancer. Sometimes, the only way to be sure of a liver cancer diagnosis is to take a biopsy sample and look at it in the pathology lab. But in some cases, doctors can be quite certain that a person has liver cancer based on the results of imaging tests such as CT and MRI scans. […] If a biopsy is done, the samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells.

• #1 Diagnosis of liver cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/liver/diagnosis

  Liver function tests (also called a liver panel) are a group of blood chemistry tests that are often ordered together. While they do not diagnose liver cancer, they can tell the doctor that there may be a problem with the liver. […] To diagnose liver cancer, a CT scan is done 4 times. This is called a 4-phase, or multiphase, CT scan. A CT scan is first done without any contrast medium. The next 3 scans are done after contrast medium is injected into a vein. The way the contrast medium flows through the liver can tell doctors if a tumour in the liver is cancerous. When doctors identify liver cancer with a CT scan, they dont need to do a liver biopsy. […] In most cases, doctors use a CT scan to diagnose liver cancer. If they cant confirm that there is a tumour in the liver based on the imaging test results, doctors may do a liver biopsy.

• #1 Liver Cancer Diagnosis – NCI

  https://www.cancer.gov/types/liver/what-is-liver-cancer/diagnosis

  Tests that examine the liver and the blood are used to detect and diagnose liver cancer. Every person will not receive all the tests described below. […] The following tests and procedures may be used: […] A biopsy is not always needed to diagnose liver cancer. Sometimes the doctors can diagnose liver cancer based on the results of imaging tests such as CT scans and MRI. […] After primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process of determining the size and location of the cancer and whether it has spread is called staging. […] Some of the tests and procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process. A positron emission tomography (PET) scan may also be used.

• #1 Liver cancer: screening, diagnosis and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/liver-cancer-screening-diagnosis-and-management

  The hallmark radiological features of HCC are hyperenhancement during the hepatic arterial phase, followed by washout during the portal venous and delayed phases. […] Owing to its distinct radiological features, HCC is the only solid organ tumour that does not mandate tissue confirmation for diagnosis. […] Lesions displaying important hallmarks of HCC on imaging (i.e. arterial phase hyperenhancement, non-peripheral washout and capsule enhancement) is sufficient for non-invasive diagnosis. […] AFP is the only biomarker to fulfil the standardised biomarker validation. AFP has been used as a biomarker in HCC surveillance. […] The addition of AFP to ultrasound for surveillance improves sensitivity for early HCC detection compared with ultrasound alone, but at the cost of a lower specificity.

• #1 Liver cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664

  Liver cancer is one of the cancers where we may not need a biopsy to make decisions about your care. Sometimes, liver cancer can be reliably diagnosed on imaging studies such as CT scans or MRIs. It’s important to talk to your doctor and your medical team to determine whether a biopsy is necessary as part of your care plan. […] Tests and procedures used to diagnose liver cancer include: Blood tests may reveal liver function abnormalities. Your doctor may recommend imaging tests, such as an ultrasound, CT and MRI. […] Sometimes it’s necessary to remove a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer. During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.

• #1 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. […] Laboratory evaluation of patients with newly diagnosed HCC should include testing to determine the severity of the underlying liver disease.

• #1 Liver Cancer – Symptoms, Cause, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/liver-cancer

  Generally, high-risk patients including cirrhotic patients and patients with chronic viral hepatitis B infection, need to undergo the surveillance program for HCC which is an ultrasound of the upper abdomen and blood test for tumor marker (AFP) every six months. These tests aim for early detection of liver cancer. […] If abnormal mass is detected from ultrasound, further computed tomography (CT scan) or magnetic resonance imaging (MRI scan) will be performed to determine the nature of the mass. The typical pattern of enhancement from either a CT scan or MRI together with a history of underlying chronic liver disease is usually sufficient to make the diagnosis of HCC without a liver biopsy needed. […] However, in some patients with chronic liver disease which radiological image showed an atypical pattern for HCC diagnosis, and vice versa, the typical radiological pattern for HCC shows in patients who have no underlying chronic liver disease. In this case, a biopsy may be needed to confirm the diagnosis.

• #1 Liver Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,BLivD1

  Needle biopsy […] A thin, hollow needle is put through your skin. It goes into the liver tumor to get a tiny piece of it. A needle biopsy is normally done during a CT scan or ultrasound. The imaging tests help your healthcare provider be sure the needle is going into the tumor. […] Laparoscopic biopsy […] During laparoscopy, small cuts are made in your belly. Your healthcare provider then puts long surgical tools into those cuts. One of these tools has a tiny lighted video camera on the end that projects images on a screen. This allows your provider to look at the surface of your liver and nearby organs. If tumors or changed areas are seen, the tools put in the other cuts can be used to take out samples for testing. […] Surgical biopsy […] This is the most common type of biopsy used for liver cancer. In this case, the tissue for biopsy is taken out during surgery to remove the tumor.

• #1 Liver cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664

  Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans. […] There are different methods of staging liver cancer. For example, one method uses Roman numerals I through IV, and another uses letters A through D. Your doctor uses your cancer’s stage to determine your treatment options and your prognosis.

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

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

  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.

• #1 Liver Cancer – Diagnosis & Disease Information

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

  However, because not all tumors present with these enhancement patterns, the liver imaging reporting and data system (LI-RADS) was developed to aid classification of hepatocellular carcinoma lesions in a standardized manner. […] Using LI-RADS, lesions can be characterized as LR-1 (definitely benign), LR-2 (probably benign), LR-3 (intermediate risk of hepatocellular carcinoma), LR-4 (probably hepatocellular carcinoma), or L5-5 (definitely hepatocellular carcinoma).

• #1 Liver Cancer Diagnosis & Stages | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/liver/diagnosis

  To examine you for fibrolamellar-hepatocellular carcinoma, a biopsy is crucial because we learn about what cells are involved in the cancer. […] Having information about the genetic makeup of your tumor can help us select the most effective therapies for you. […] The stage of liver cancer you have refers to how far the disease has spread through your body. […] Information from staging tests can help us figure out whether: the tumor is in one area of the liver and can be removed; the tumor is in one area but cannot be completely removed safely; cancer has spread throughout the liver or to other parts of the body; cancer has reoccurred in the liver or in another part of the body after it was eliminated with a first round of treatment. […] Well determine the best treatment approach for you based on the stage of your disease.

• #1 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).

• #1 Liver Cancer Screening – NCI

  https://www.cancer.gov/types/liver/what-is-liver-cancer/screening

  Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. […] If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests. […] Doctors use these screening tests to find, or diagnose, liver cancer. Learn more about Liver Cancer Diagnosis. […] False-negative test results can occur. Screening test results may appear to be normal even though liver cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms. […] False-positive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by diagnostic tests and procedures, such as a liver biopsy, which also have risks. […] Procedures to diagnose liver cancer can cause complications. Abnormal screening results may be followed up with a liver biopsy to diagnose liver cancer.

• #1 Advancements in the Diagnosis of Hepatocellular Carcinoma

  https://www.mdpi.com/2673-8937/3/1/5

  HCC screening tools have been utilized in high-risk patients to identify HCC early. In addition to abdominal ultrasound, tumor biomarkers have been incorporated into the screening protocol. While AFP is the primary biomarker used in addition to ultrasound for HCC screening, studies are beginning to elucidate the utility of other biomarkers for HCC screening and prognosis. […] These tumor markers not only have utility in diagnosing HCC, but also have utility in predicting severity and spread of disease and in monitoring for recurrence of cancer after treatment. For example, a study testing for positivity of three tumor markers (AFP cutoff of 20 ng/mL, AFP-L3 ratio cutoff of 10%, and DCP cutoff 40 mAU/mL) found that a greater number of markers over the cutoff values were associated with a greater size and number of lesions, more poorly differentiated cancer, more infiltrative growth, and portal vein invasion.

• #1 Biomarkers for diagnosis and therapeutic options in hepatocellular carcinoma | Molecular Cancer | Full Text

  https://molecular-cancer.biomedcentral.com/articles/10.1186/s12943-024-02101-z

  Given the challenges in treating advanced-stage HCC, even with the advent of novel systemic therapies, it is imperative to explore improved methods for early detection, diagnosis, and prevention. […] The application of liquid biopsies, mainly circulating tumor DNA (ctDNA) and extracellular vesicles, has also garnered interest as a non-invasive method for the early detection and monitoring of HCC. […] This review will discuss current findings of biomarkers for early screening, detection, and diagnosis, as well as treatment options and response. […] The most common fluid obtained in clinical settings is blood. […] Current research directions aim to push forward the ability of liquid biopsy to obtain as much valuable information as a typical biopsy. […] The following will discuss the current and potential biomarkers in various aspects of HCC to develop a more systematic and comprehensive panel for economical but sensitive HCC screening and diagnostic methods to improve patient outcomes.

• #1 Diagnosis of hepatocellular carcinoma

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

  Liver biopsy offers a safe and effective means to confirm suspicious lesions for HCC. Cytologic and histologic samples can be obtained by percutaneous fine-needle aspiration (FNA) and needle core biopsy, respectively, under US or CT guidance. The diagnostic accuracy of liver biopsy is greater when both FNA and core biopsy techniques are used simultaneously than when either is used alone. […] The diagnosis of HCC poses many challenges which can vary among different regions and centers. AFP and US imaging are most often used every 6 months for surveillance purposes in high-risk individuals. In the presence of a rising AFP or suspicion of underlying malignancy, surveillance intervals should be shortened and more sensitive imaging techniques such as multiphasic CT scan or MRI can be applied.

• #1 Liver Cancer Diagnosis & Stages | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/liver/diagnosis

  Accurate diagnosis and staging of liver cancer is critical for the best outcome. […] Its very important to get an accurate diagnosis of primary liver cancer so that your condition can be treated the right way from the beginning. […] Along with a diagnosis, well determine the extent (stage) of your cancer through blood tests, diagnostic imaging, biopsy, and genetic testing of your tumor. […] A test that measures the level of a protein produced by the liver called alpha fetoprotein (AFP) can indicate that you have fibrolamellar-hepatocellular carcinoma. […] Imaging tests help us learn about the exact location of your tumor and assess the condition of the organ and surrounding tissues and blood vessels. […] A biopsy is an important part of your diagnosis because it lets us know how extensive your tumor is and what types of cells it contains.

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

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

  Cancer staging for HCC allows your healthcare provider to determine how advanced it is. […] Treatments include: Surgery: The surgical treatments for HCC are hepatectomy (removing the diseased part of your liver) or a liver transplant. […] If surgery isn’t an option, there are other treatments to ease your symptoms, slow the tumors growth and help you live longer. […] Catching HCC early, when surgery can treat it, delivers the best possible outcomes.

• #1 Liver Cancer Diagnosis | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancer/liver/diagnosis

  A correct diagnosis of your cancer is essential to your best chance for a cure. About 10% to 18% of the outside cases we review at Roswell Park result in a change of diagnosis either a reversal of diagnosis (someone received a cancer diagnosis but does not actually have cancer, or someone has cancer but was told no cancer was present) or our pathologists identify a type of cancer that is different from the one that was originally diagnosed; this information can dramatically alter the treatment plan. Seek a second opinion at Roswell Park before making any surgery or treatment decisions.

• #1 Liver Cancer Diagnosis and Treatment – A Detailed Guide

  http://www.hcgoncology.com/types-of-cancers/liver-cancer-diagnosis-and-treatment/

  The success of liver cancer treatment depends upon the stage of diagnosis, response to treatment, and overall health. […] Computed tomography is considered the best imaging technique for diagnosing liver cancer. […] Some of the newest treatments for liver cancer are immunotherapy, targeted therapy, and gene therapy. […] Today, we have advanced technologies and treatment methods that allow us to treat liver cancers successfully, provided they are in their early stages.

• #2 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. […] Laboratory evaluation of patients with newly diagnosed HCC should include testing to determine the severity of the underlying liver disease.

• #2 Liver Cancer: Diagnosis

  https://healthlibrary.wjmc.org/library/diseasesconditions/Adult/CompAltMed/34,BLivD1

  Liver function tests (LFTs) […] These tests can show liver irritation and inflammation. They can’t tell for sure if you have liver cancer. But if the tests show liver damage, your healthcare provider will likely do other tests to look for the cause of the damage. The damage could be from many different things, like cirrhosis, hepatitis, or cancer. […] Imaging tests may also be done to look for liver cancer. […] Ultrasound […] This is often the first test done if your healthcare provider suspects liver cancer. An ultrasound is easy to do and doesn’t use radiation. It’s very good at showing whether a liver tumor is a fluid-filled sac (cyst) that’s likely not cancer, or a solid mass that’s more likely to be cancer. An ultrasound uses sound waves to look for changes in the liver. The sound waves bounce off your insides and send back a series of signals. A computer turns these signals into images.

• #2 Advancements in the Diagnosis of Hepatocellular Carcinoma

  https://www.mdpi.com/2673-8937/3/1/5

  Common screening options for HCC include abdominal ultrasounds and alpha-fetoprotein (AFP) biomarker testing. Abdominal ultrasound is the preferred imaging modality over computed tomography (CT) and magnetic resonance imaging (MRI) due to the inexpensive cost and widespread availability. The sensitivity of abdominal ultrasound for early HCC detection is around 45%. Additional screening with AFP biomarker testing may improve HCC detection rates. AFP is a serum glycoprotein and elevations are associated with liver malignancy. AFP levels greater than 400–500 ng/mL are diagnostic for HCC. The sensitivity of HCC detection with a combination approach is around 63%, however, ultrasound with concurrent AFP testing has a lower specificity than ultrasound alone. […] Current standards for diagnostic modalities for hepatocellular carcinoma include imaging with CT, MRI, and ultrasound, as well as tissue biopsy, which has been strongly recommended before transplantation with uncertain imaging. The specificity and positive predictive value of tumor biopsy is 100%, but the sensitivity may vary between 66% to 93%, depending on the size of the needle and nodule, thus making ruling out diagnosis less reliable with biopsy. Patients with negative biopsy findings should undergo surveillance via imaging. Imaging is a non-invasive option compared to traditional tissue biopsy, and MRI is the gold standard for imaging of HCC due to its diagnostic accuracy and significantly higher sensitivity, as well as significantly lower negative likelihood ratio as compared to CT.

• #2 Tests and next steps for liver cancer – NHS

  https://www.nhs.uk/conditions/liver-cancer/tests-and-next-steps/

  You will need tests and scans to check for liver cancer if the GP refers you to a specialist. […] These tests can include: blood tests, scans, like an ultrasound scan, CT scan or MRI scan, collecting a small sample of cells from the liver (called a biopsy), to be checked for cancer. […] If you’ve already had another kind of cancer and the specialist thinks it might have spread to your liver (secondary liver cancer) you may also have a PET scan. […] It can take several weeks to get the results of your tests. […] A specialist will explain what the results mean and what will happen next. […] If you’ve been told you have liver cancer, you may need more tests. […] These, along with the tests you’ve already had, will help the specialists find out the size of the cancer and how far it’s spread (called the stage).

• #2 Liver cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664

  Liver cancer is one of the cancers where we may not need a biopsy to make decisions about your care. Sometimes, liver cancer can be reliably diagnosed on imaging studies such as CT scans or MRIs. It’s important to talk to your doctor and your medical team to determine whether a biopsy is necessary as part of your care plan. […] Tests and procedures used to diagnose liver cancer include: Blood tests may reveal liver function abnormalities. Your doctor may recommend imaging tests, such as an ultrasound, CT and MRI. […] Sometimes it’s necessary to remove a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer. During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.

• #2 Liver Cancer: Symptoms, Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9418-liver-cancer

  Primary liver cancer is a life-threatening illness and one of the fastest-growing cancer types in the United States. […] Your healthcare provider will do a physical examination. Theyll ask about your symptoms and may do the following tests: […] Your provider may do a liver biopsy if blood and other tests detect cancer in your liver. Biopsies are the most reliable way to confirm a liver cancer diagnosis. […] Cancer staging is how healthcare providers diagnose disease and plan treatment. Providers use the Barcelona Clinic Liver Cancer system (BCLC) to stage liver cancer. […] Healthcare providers may treat liver cancer with medical treatments or surgery. […] You may also benefit from tests if you drink large amounts of alcohol. […] Successful liver transplants can cure liver cancer.

• #2 Advancements in the Diagnosis of Hepatocellular Carcinoma

  https://www.mdpi.com/2673-8937/3/1/5

  Liquid biopsy hinges on the analysis of circulating tumor cells (CTCs), circulating cell-free tumor DNA (ctDNA), and exosomes as biomarkers in the blood of patients with cancer, primarily those with solid tumors or their metastatic foci. […] Molecular imaging is a diagnostic technique with great potential and is rapidly increasing in scope. With continued research and exploration, it can greatly improve screening, early diagnosis, and patient outcomes for those with HCC.

• #3 Diagnosing Liver Cancer | American Cancer Society | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/how-diagnosed.html

  Your doctor could order blood tests for a number of reasons: To help diagnose liver cancer (although the diagnosis can’t be made on a blood test alone), To help determine what might have caused your liver cancer, To learn how well your liver is working, which can affect what treatments you can have, To see how well treatment is working, To look for signs that the cancer has come back after treatment. […] AFP is a protein that can sometimes be found at high levels in the blood of people with liver cancer. If AFP levels are very high in someone with a liver tumor, it can be a sign that liver cancer is present. […] This test can be used to look for possible signs that the cancer has come back (recurred).

• #3 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. […] Laboratory evaluation of patients with newly diagnosed HCC should include testing to determine the severity of the underlying liver disease.

• #3 Advancements in the Diagnosis of Hepatocellular Carcinoma

  https://www.mdpi.com/2673-8937/3/1/5

  Common screening options for HCC include abdominal ultrasounds and alpha-fetoprotein (AFP) biomarker testing. Abdominal ultrasound is the preferred imaging modality over computed tomography (CT) and magnetic resonance imaging (MRI) due to the inexpensive cost and widespread availability. The sensitivity of abdominal ultrasound for early HCC detection is around 45%. Additional screening with AFP biomarker testing may improve HCC detection rates. AFP is a serum glycoprotein and elevations are associated with liver malignancy. AFP levels greater than 400–500 ng/mL are diagnostic for HCC. The sensitivity of HCC detection with a combination approach is around 63%, however, ultrasound with concurrent AFP testing has a lower specificity than ultrasound alone. […] Current standards for diagnostic modalities for hepatocellular carcinoma include imaging with CT, MRI, and ultrasound, as well as tissue biopsy, which has been strongly recommended before transplantation with uncertain imaging. The specificity and positive predictive value of tumor biopsy is 100%, but the sensitivity may vary between 66% to 93%, depending on the size of the needle and nodule, thus making ruling out diagnosis less reliable with biopsy. Patients with negative biopsy findings should undergo surveillance via imaging. Imaging is a non-invasive option compared to traditional tissue biopsy, and MRI is the gold standard for imaging of HCC due to its diagnostic accuracy and significantly higher sensitivity, as well as significantly lower negative likelihood ratio as compared to CT.

• #4 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. […] Laboratory evaluation of patients with newly diagnosed HCC should include testing to determine the severity of the underlying liver disease.

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