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World J Gastroenterol. Dec 21, 2013; 19(47): 8808-8821
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.8808
Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?
Edoardo G Giannini, Alessandro Cucchetti, Virginia Erroi, Francesca Garuti, Federica Odaldi, Franco Trevisani
Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy
Alessandro Cucchetti, Federica Odaldi, Dipartimento di Scienze Mediche Chirurgiche, Unità di Chirurgia Generale e dei Trapianti, 40138 Bologna, Italy
Virginia Erroi, Francesca Garuti, Franco Trevisani, Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, 40138 Bologna, Italy
Author contributions: Giannini EG, Trevisani F and Cucchetti A contributed to conception and design of the manuscript drafted the article and revised it; Erroi V, Garuti F and Odaldi F contributed to the final revision of the version to be published.
Correspondence to: Franco Trevisani, Professor, Dipartimento di Scienze Mediche Chirurgiche, Unità di Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, via Albertoni, 15, 40138 Bologna, Italy.
Telephone: +39-51-6362923 Fax: +39-51-6362930
Received: September 30, 2013
Revised: October 31, 2013
Accepted: November 18, 2013
Published online: December 21, 2013

Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

Keywords: Hepatocellular carcinoma, Surveillance, Screening, Ultrasonography, Cost-effectiveness

Core tip: This article deals with the role of surveillance for early diagnosis of hepatocellular carcinoma in patients at risk. It addresses several topics on this issue, including how to best perform surveillance (tools and interval), its results in terms of cancer stage, patient survival, cost-effectiveness, pitfalls and actual under-(mis-)use.