How should hepatocellular carcinoma (HCC) be monitored in patients with cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Many authors contend that the combination of arterial enhancement and washout on CT scanning or MRI offers greater diagnostic power for HCC than does guided liver biopsy. [70, 71] Indeed, guided liver biopsies have a 20-30% false negative rate in making the diagnosis of HCC. Current guidelines support the use of CT scanning and MRI in confirming the presence of HCC. Biopsy is not required in order to define a lesion as HCC. [69] However, CT scanning or ultrasonographically guided liver biopsy may be useful when a nodule’s enhancement characteristics are not typical for HCC.

Patients with a diagnosis of HCC and no evidence of extrahepatic disease, as determined by chest and abdominal CT scans and by bone scan, should be offered curative therapy. Commonly, this therapy entails liver resection surgery for patients with Child Class A cirrhosis and an accelerated course to liver transplantation for patients with Child Class B or C cirrhosis.

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