What is the diagnostic approach for hepatocellular carcinoma (HCC)?

From the Guidelines

The diagnostic approach for hepatocellular carcinoma (HCC) involves a combination of imaging, laboratory tests, and sometimes biopsy, with the most recent guidelines prioritizing non-invasive imaging techniques, such as contrast-enhanced CT or MRI, for diagnosis and staging 1.

Diagnostic Approach

The diagnosis of HCC is based on a combination of clinical, laboratory, imaging, and pathology examinations. For patients with cirrhosis or chronic hepatitis B, surveillance should be performed with ultrasound every 6 months. When a suspicious lesion is found, diagnosis can often be established non-invasively using contrast-enhanced CT or MRI.

• Lesions larger than 1 cm showing arterial phase hyperenhancement followed by washout in the portal venous or delayed phase are highly suggestive of HCC.
• Alpha-fetoprotein (AFP) should be measured as an adjunct diagnostic marker, with levels above 400 ng/mL strongly supporting an HCC diagnosis, though many tumors do not produce elevated AFP.
• Liver biopsy is reserved for cases where imaging is inconclusive, particularly for lesions 1-2 cm in size with atypical imaging features.

Imaging Techniques

• Contrast-enhanced CT or MRI are the preferred imaging modalities for diagnosing HCC, due to their high sensitivity and specificity 1.
• Ultrasound is useful for surveillance, but its sensitivity and specificity are lower compared to CT or MRI.
• The typical hallmark of HCC on imaging is the combination of hypervascularity in the late arterial phase and washout on portal venous and/or delayed phases.

Staging and Treatment

• The Barcelona Clinic Liver Cancer (BCLC) staging system should be applied after diagnosis to guide treatment decisions, as it incorporates tumor burden, liver function (Child-Pugh score), and patient performance status.
• Early diagnosis is crucial because it allows for potentially curative treatments like resection, transplantation, or ablation, significantly improving the 5-year survival rate from less than 10% for advanced disease to over 70% for early-stage HCC 1.

From the FDA Drug Label

None of the provided drug labels directly address the diagnostic approach for hepatocellular carcinoma (HCC).

The FDA drug label does not answer the question.

From the Research

Diagnostic Approach for Hepatocellular Carcinoma (HCC)

The diagnostic approach for HCC involves a combination of imaging studies and, in some cases, biopsy. The following are the key points to consider:

• Imaging studies play a crucial role in the diagnosis and staging of HCC 2, 3, 4.
• The imaging techniques commonly used for the diagnosis of HCC include:
  • Ultrasound
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
• Biopsy is infrequently required prior to treatment, and the diagnosis of HCC is strongly dependent on hemodynamic features (arterial hypervascularity and washout in the venous phase) on dynamic imaging 2, 4.
• Accurate staging of HCC is important in determining prognosis and in deciding optimal treatment for each patient 2, 5, 6.
• The Barcelona Clinic Liver Cancer algorithm is the most widely used staging system 5, 6.
• Surveillance of HCC has been proposed and recommended in clinical guidelines to obtain earlier diagnosis, and it is recommended to perform surveillance in patients with cirrhosis susceptible of treatment, using ultrasonography every 6 months 4.

Imaging Diagnosis and Staging

The imaging diagnosis and staging of HCC involve the use of various imaging modalities, including:

• CT and MRI with extracellular contrast agents 3
• MRI with hepatobiliary contrast agents 3
• Ultrasound 4
• The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis 4.

Treatment and Management

The treatment and management of HCC depend on the stage of the disease and the underlying liver function. The following are the key points to consider:

• Standard stage-adapted treatments are based on the widely applied Barcelona Clinic Liver Cancer staging system 5, 6.
• Treatment options include liver resection, transplantation, interventional treatments such as thermal ablation and transarterial therapies, and systemic treatment with the tyrosine kinase inhibitor sorafenib 5, 6.
• Treatment of HCC is multidisciplinary and requires a close cooperation between various disciplines such as hepatology, visceral surgery, radiology, and oncology 5.