Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1367-1382
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1367
Biomarkers vs imaging in the early detection of hepatocellular carcinoma and prognosis
Lavinia Alice Balaceanu
Lavinia Alice Balaceanu, Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Sf. Ioan Clinical Emergency Hospital, Bucharest 42122, Romania
Author contributions: Balaceanu LA conceived of, designed and performed the review of the literature, and wrote the manuscript.
Conflict-of-interest statement: The author declares no potential conflicts of interest in relation to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lavinia Alice Balaceanu, PhD, Associate Professor, Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Sf. Ioan Clinical Emergency Hospital, Soseaua Vitan-Barzesti No. 13, Bucharest 42122, Romania.
Telephone: +40-0213345190
Received: February 20, 2019
Peer-review started: February 20, 2019
First decision: March 11, 2019
Revised: April 7, 2019
Accepted: May 2, 2019
Article in press: May 3, 2019
Published online: June 26, 2019

Hepatocellular carcinoma (HCC) is the 5th most frequently diagnosed cancer in the world, according to the World Health Organization. The incidence of HCC is between 3/100000 and 78.1/100000, with a high incidence reported in areas with viral hepatitis B and hepatitis C, thus affecting Asia and Africa predominantly. Several international clinical guidelines address HCC diagnosis and are structured according to the geographical area involved. All of these clinical guidelines, however, share a foundation of diagnosis by ultrasound surveillance and contrast imaging techniques, particularly computed tomography, magnetic resonance imaging, and sometimes contrast-enhanced ultrasound. The primary objective of this review was to systematically summarize the recent published studies on the clinical utility of serum biomarkers in the early diagnosis of HCC and for the prognosis of this disease.

Keywords: Hepatocellular carcinoma, Biomarkers, Imaging, Ultrasonography, Computed tomography, Magnetic resonance imaging

Core tip: Hepatocellular carcinoma (HCC) is an important cause of morbidity and mortality worldwide. Current HCC screening and diagnostic guidelines are based on imaging techniques-ultrasonography for screening, and dynamic contrast-enhanced computed tomography, magnetic resonance, and ultrasound for diagnosis. The use of biomarkers is promising but the diverse aetiology and complex pathophysiological mechanisms of HCC make it difficult to find an ideal combination. This review systematically summarizes the existing data on the role of biomarkers in early diagnosis and prognosis of HCC, to promote efforts to find alternatives to the imaging investigations which are expensive and not always accepted by patients.