Hepatocellular carcinoma in patients without cirrhosis

Table 2 Recommendations for hepatocellular carcinoma screening and surveillance by medical societies

Medical societies	Cirrhotic individuals		Non-cirrhotic individuals		Both populations
	At-risk population	Additional notes	At-risk population	Additional notes	Surveillance tests	Frequency
EASL[8]	Individuals with Child-Pugh A and B, or Child-Pugh C if awaiting LT	N/A	Chronic HBV infection with PAGE-B score ≥ 10	No current recommendation for individuals with chronic liver disease and advanced fibrosis without cirrhosis	Ultrasound ± AFP	Every 6 months
AASLD[9]	Individuals with Child-Pugh A or B with any etiology, and Child-Pugh C if awaiting LT	CT or MRI is suggested if limited liver visualization with ultrasound	Chronic HBV infection: From endemic countries (women > 50 years old and men > 40 years old); From Africa at an earlier age; Family history of HCC; PAGE-B Score ≥ 10	Same as the cirrhotic population	Ultrasound ± AFP	Every 6 months
AGA[10]	All individuals with cirrhosis	CT or MRI is suggested if limited liver visualization with ultrasound	N/A	Screening should be considered in advanced liver fibrosis	Ultrasound ± AFP	Every 6 months
NCCN[86]	Individuals with Child-Pugh A or B with any etiology, and Child-Pugh C if awaiting LT	CT or MRI is suggested if limited liver visualization with ultrasound	Chronic HBV infection: Asian women > 50 years old and men > 40 years old); Family history of HCC; African/North American Blacks	Same as the cirrhotic population	Ultrasound ± AFP	Every 6 months
ESMO[85]	All individuals with cirrhosis	N/A	Chronic HBV infection with moderate to high HCC risk score at the onset of nucleoside analogue therapy	N/A	Ultrasound ± AFP	Every 6 months
BSG[84]	All individuals with cirrhosis	N/A	Chronic HBV infection: From endemic countries (women > 50 years old and men > 40 years old); Family history of HCC; African Black people	No current recommendation for individuals with non-cirrhotic MASLD	Ultrasound + AFP	Every 6 months
APASL[82]	All individuals with cirrhosis	N/A	Chronic HBV infection: From endemic countries (women > 50 years old and men > 40 years old); Family history of HCC; African individuals > 20 years old	No current recommendation for chronic HCV individuals with bridging fibrosis	Ultrasound ± AFP	Every 6 months
JSH[83]	All individuals with cirrhosis	Individuals with cirrhosis type B and C should undergo dynamic CT/MRI every 6-12 months, which is optional	Individuals with chronic HBV and HCV	N/A	Ultrasound + tumor marker	Every 6 months for chronic hepatitis B/C and non-viral cirrhosis; Every 3-4 months for cirrhosis types B and C

AASLD: American Association for the Study of Liver Disease; AFP: Alpha fetoprotein; AGA: American Gastroenterological Association; APASL: Asia-Pacific Association for the Study of the Liver; BSG: British Society of Gastroenterology; CT: Computed tomography; EASL: European Association for the Study of the Liver; ESMO: European Society of Medical Oncology; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; JSH: Japanese Society of Hepatology; LT: Liver transplantation; MRI: Magnetic resonance imaging; N/A: Not available; NAFLD: Non-alcoholic fatty liver disease; NCCN: National Cancer Comprehensive Network; PAGE-B: Platelet-age-gender-hepatitis B virus.