Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?

Figure 1 Prorok’s postulates: Paradigm of surveillance for early diagnosis of hepatocellular carcinoma.

Figure 2 Recall policy and diagnostic algorithm proposed by the Italian Association for the Study of the Liver for cirrhotic patients with a nodule detected during ultrasound surveillance. ¹Note that, since magnetic resonance (MR) or computed tomography (CT) are anyhow needed for staging in the case of hepatocellular carcinoma diagnosis made by contrast-enhanced ultrasonography (CEUS), a pragmatic approach is to perform MR or CT as the first-line imaging technique for diagnosis, and to resort to CEUS when radiological imaging techniques provide inconclusive features (reprinted with permission)[102].