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Published on: September 30, 2021
Hepatocellular carcinoma screening and diagnosis
Morris Sherman1, Massimo Colombo2
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Hepatocellular carcinoma (HCC) screening is recommended for high-risk patients using ultrasound and biomarkers. Current guidelines suggest optimal screening intervals and diagnostic tools for early detection and management of liver cancer.
Area of Science:
- Hepatology
- Oncology
- Diagnostic Imaging
Background:
- Major liver disease societies recommend screening for hepatocellular carcinoma (HCC).
- Risk stratification for HCC screening includes patients with hepatitis B and those with cirrhosis.
- Current screening methods involve ultrasound, with additional biomarker use in Asia.
Purpose of the Study:
- To review current recommendations and practices for HCC screening.
- To discuss the role of risk scores, screening intervals, and diagnostic tools in HCC management.
- To evaluate the utility of biomarkers in conjunction with imaging for HCC detection.
Main Methods:
- Review of guidelines and literature on HCC screening protocols.
- Analysis of risk score development for specific patient populations.
- Discussion of imaging criteria and histopathological stains for HCC confirmation.
Main Results:
- Ultrasound is the primary screening tool, with an ideal interval of 6 months.
- Biomarker utility in addition to ultrasound has not been definitively proven.
- Radiological criteria and special stains aid in confirming HCC and differentiating lesions.
Conclusions:
- HCC screening is crucial for early detection and improved patient outcomes.
- A combination of risk assessment, appropriate screening intervals, and diagnostic tools is essential for effective HCC management.
- Further research is needed to validate the role of biomarkers in HCC screening.
Abstract:
All the major liver disease societies have recommended screening for hepatocellular carcinoma (HCC). The target population for HCC screening has been defined by cost-efficacy analyses and by risk scores. Risk scores have been developed for patients with hepatitis B, regardless of the presence of cirrhosis, and for other patients with cirrhosis. Screening is with ultrasound; however, in Asia biomarkers are also used. The additional value of biomarkers has not been demonstrated. The ideal screening interval is 6 months; in Japan shorter intervals are used. Screening detects small lesions that require confirmation of HCC. There are radiological criteria that help determine whether a biopsy is necessary. Special stains can determine whether a lesion that closely resembles normal or dysplastic tissue is HCC. All these tools should be used in the management of patients undergoing HCC screening.
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