Surveillance and Assessment
ÎPatients 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.
ÎPatients 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).
ÎSurveillance for HCC should be performed using ultrasonography (II). ÎPatients should be screened at 6 month intervals (II).
ÎThe surveillance interval does not need to be shortened for patients at higher risk of HCC (III).
ÎNodules 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).
ÎNodules > 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).
ÎBiopsies 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).
ÎIf 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).