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. 2026 Sep 28;16:1957598. doi: 10.3389/fonc.2026.1957598

Figure 2.

Infographic shaped as a pyramid divided into three levels representing evidence tiers for clinical tools in hepatology. The top blue section lists established clinical practice, including liver function, tumor burden, and patient preferences, with a clinical role in direct decision-making. The middle green section, investigational tools like radiomics, ctDNA, genomic profiling, immune profiling, artificial intelligence, and digital pathology, are for research use and support risk stratification but are not treatment determinants. The bottom pink section presents future hypotheses such as multi-omics, digital twins, wearables, and learning health systems, which require validation and are not currently actionable. A gradient arrow on the right indicates higher to lower clinical evidence.

Evidence tiers of precision technologies in hepatocellular carcinoma. Precision technologies are classified into three evidence tiers according to their current level of clinical validation and actionability. Established clinical practice, including assessment of liver function, portal hypertension, tumor burden, performance status, and treatment eligibility, forms the foundation of HCC management. Investigational clinical tools, including radiomics, circulating tumor DNA (ctDNA), genomic and immune profiling, artificial intelligence (AI), and digital pathology, may provide additional information for risk stratification, biological characterization, treatment-response assessment, or multidisciplinary discussion, but are not established stand-alone determinants of treatment. Future hypotheses, including multi-omics integration, digital twins, digital biomarkers, and learning health systems, require substantial prospective validation before routine clinical implementation. Precision technologies are therefore intended to complement, rather than replace, guideline-based HCC management.