[Early diagnosis of hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is considered to develop either on a background of preneoplastic lesions as multistep carcinogenesis or on a liver without such a lesion as de novo. The latter course can be assumed by our clinical experience of imaging diagnosis and by follow up studies of alpha fetoprotein (AFP) producing HCCs. Although serial checkup of AFP is important, serological or genetic approach is little use for early detection of HCC. At present, imaging diagnosis especially ultrasound is the best modality for detecting early developing HCC. The most reliable way for the final diagnosis of the detected mass is done by aspiration histology using a 21G needle with ultrasound guidance. Recent new imaging modalities such as contrast enhanced ultrasound using CO2 microbubbles or CTAP are not so reliable as aspiration histology, especially in tumors less than 15 mm in diameter.