Table 2.
Summary of regular surveillance and non-invasive diagnostic criteria
| Guidelines | Regular surveillance |
Non-invasive diagnostic criteria |
|||
|---|---|---|---|---|---|
| High-risk groups | Test | Interval | Size | Serum AFP level & typical image findings | |
| KLCSG-NCC | HBV/HCV positive or cirrhosis | US and AFP | N/A | ≥1 cm | Typical findings* on 1 or more (2 or more†) image‡ |
| <1 cm | Typical findings* on 2 or more image‡ & increased serum AFP with an increasing trend over time in patients with suppressed hepatitis activity | ||||
| JSH | - Cirrhotic patients (extremely high risk) | US AFP/DCP/AFP-L3 | - 3-4 Mo (extremely high risk); CT/MRI (optional) q 6-12 Mo | Any size | Typical findings* on 1 image‡ |
| - Hepatitis B or C patients (high-risk) | - 6 Mo (high-risk) | ||||
| >1 cm | Early-phase contrast enhancement & no delayed-phase washout on 1 image (>1cm) + Typical findings* on optional testing‡ | ||||
| >1.5 cm | No early-phase contrast enhancement & delayed-phase washout on 1 image (>1.5cm) + Typical findings* on optional testing‡ | ||||
| APASL | Cirrhosis with HBV or HCV infection | US and AFP | 6 mo | According to tumor vascularity in the arterial phase (hyper- or hypovascular) | |
| EASL–EORTC | - Cirrhotic patients | US | - 6 mo | 1-2 cm | Typical findings* on 1 (only in centers with high-end radiological equipment) or 2 images‡ |
| - Non-cirrhotic HBV carriers with active hepatitis or family history of HCC | - 3-4 mo (1. Where a nodule < 1 cm has been detected, 2. In the follow-up strategy after resection or locoregional therapies) | ||||
| - Non-cirrhotic patients with chronic hepatitis C and advanced liver fibrosis F3 | |||||
| ≥2 cm | Typical findings* on 1 image‡ | ||||
| Typical findings on two images if AFP <400 ng/mL | |||||
| ESMO-ESDO | - Cirrhotic patients (irrespective of etiology) | US | 6 mo | According to the typical vascular hallmark of HCC (hypervascular in the arterial phase with washout in the portal venous or delayed phases) | |
| - Non-cirrhotic HBV carriers with high viral load | |||||
| - Non-cirrhotic patients with chronic hepatitis C and advanced fibrosis (at least Metavir F3) | |||||
| AASLD | See text | US | 6 mo | 1-2 cm | Typical findings on two images |
| ≥2 cm | Typical findings on single image or AFP ≥200 ng/mL | ||||
| NCCN | - Cirrhosis | US/AFP | 6-12 mo | >1 cm | Two classic enhancements* |
| - Without cirrhosis (Hepatitis B carriers) | |||||
| ACG | Not clearly specified, most likely cirrhotic patients | US and AFP | N/A | >1 cm | One typical characteristics* |
HBV, hepatitis B virus; HCV, hepatitis C virus; HCC, hepatocellular carcinoma; AFP, α-fetoprotein; N/A, not available.
*
Hypervascularity in the arterial phase and washout in the portal or delayed phase;
†
For 1–2-cm nodules, the diagnosis should be based on the identification of the typical hallmark of HCC in one or more imaging techniques in optimal settings (Appendices 5 and 6) and in two or more imaging techniques in suboptimal settings;
‡
Dynamic computed tomography, dynamic magnetic resonance imaging, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOBDTPA)-enhanced magnetic resonance imaging.