How is hepatocellular carcinoma (HCC) screening performed?

Updated: Jan 31, 2021
  • Author: Luca Cicalese, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Because the outcome in patients with advanced HCC is uniformly dismal, early diagnosis is crucial in order to provide effective treatment. Consequently, routine screening for HCC is recommended in patients with cirrhosis from any cause; some guidelines also recommend testing in other patients at high risk (see Guidelines). Screening is typically performed using ultrasonography (US), with or without serum alpha-fetoprotein (AFP) measurement, generally every 6 months.

AFP is elevated in 75% of cases. The level of elevation correlates inversely with prognosis. An elevation of greater than 400 ng/mL predicts for HCC with specificity greater than 95%. In the setting of a growing mass, cirrhosis, and the absence of acute hepatitis, many centers use a level greater than 1000 ng/mL as presumptive evidence of HCC (without biopsy). AFP alone is inadequate for screening purposes because of the high rate of false positives in active hepatitis; it has only 40-64% sensitivity because many tumors do not produce AFP at all or do so only at a very advanced stage. [35]

 US as a screening method is reported to have 60% sensitivity and 97% specificity in the cirrhotic population, and it has been demonstrated to be cost-effective. [36, 37]  Findings on US should then be confirmed with further imaging studies—multiphase computed tomography (CT) or magnetic resonance imaging (MRI)—and potentially biopsy.

With aggressive screening, the rate of resectable HCC diagnosed in patients who are at high risk reaches 30-50%, which is nearly twice the rate of unscreened populations. [38]  Despite the significant risk of recurrence, even in treated patients, the screening protocols appear to be cost effective in this population. [39]

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