Current Opinion about Hepatocellular Carcinoma <10 mm

Area of Science:

• Hepatology
• Diagnostic Imaging
• Oncology

Background:

• Early detection of hepatocellular carcinoma (HCC) is crucial for improved patient outcomes.
• Advancements in liver imaging aid in early HCC detection, but diagnosing very small lesions (≤10 mm) remains controversial.
• This review synthesizes current data on HCC ≤10 mm to guide diagnosis and treatment strategies.

Purpose of the Study:

• To review published data on hepatocellular carcinoma (HCC) lesions ≤10 mm.
• To discuss optimal diagnostic and treatment approaches for small HCC.
• To address the controversy surrounding the imaging diagnosis of very small HCC.

Main Methods:

• Literature review of published data on HCC ≤10 mm.
• Analysis of diagnostic accuracy of various imaging modalities for small liver lesions.
• Discussion of treatment implications based on imaging findings.

Main Results:

• Characterizing HCC <10 mm accurately remains a significant challenge.
• Contrast-enhanced ultrasound (CEUS) may offer critical insights for early treatment decisions.
• CEUS accuracy is particularly important when contrast-enhanced computed tomography (CECT) and/or contrast-enhanced magnetic resonance imaging (CEMRI) are inconclusive.

Conclusions:

• Accurate characterization of HCC <10 mm is challenging, often requiring follow-up.
• Contrast-enhanced ultrasound (CEUS) can be vital for timely treatment decisions in HCC patients.
• Repeating ultrasound for new nodules <1 cm after 3 months is recommended if initial characterization is uncertain.