Surveillance and Assessment
����Patients at high risk for developing HCC should be entered into surveillance
programs (I).
The at-risk groups for whom surveillance is recommended are identified in Table 1.
����Patients on the transplant waiting list should be screened for HCC because
in the USA the development of HCC gives increased priority for orthotopic
liver transplantation, and because failure to screen means that HCC may
progress beyond listing criteria without the physician being aware (III).
����Surveillance for HCC should be performed using ultrasonography (II).
����Patients should be screened at 6 month intervals (II).
����The surveillance interval does not need to be shortened for patients at
higher risk of HCC (III).
����Nodules found on ultrasound surveillance that are < 1 cm should be
followed with ultrasound at intervals from 3-6 months (III). If there has been
no growth over a period of up to 2 years, resume routine surveillance (III).
����Nodules > 1 cm found on ultrasound screening of a cirrhotic liver should
be investigated further with either a 4-phase multidetector computed
tomography (MDCT) scan or dynamic contrast enhanced magnetic
resonance imaging (MRI). If the appearances are typical of HCC (ie,
hypervascular in the arterial phase with washout in the portal venous or
delayed phase), the lesion should be treated as HCC. If the findings are
not characteristic or the vascular profile is not typical, a second contrast
enhanced study with the other imaging modality should be performed, or
the lesion should be biopsied (II).
����Biopsies of small lesions should be evaluated by expert pathologists. Tissue
that is not clearly HCC should be stained with all the available markers
including CD34, CK7, glypican 3, HSP-70, and glutamine synthetase to
improve diagnostic accuracy (III).
����If the biopsy is negative for patients with HCC, the lesion should be followed
by imaging at 3-6 month intervals until the nodule either disappears,
enlarges, or displays diagnostic characteristics of HCC. If the lesion
enlarges but remains atypical for HCC a repeat biopsy is recommended (III).
