Table 2.
Comparison of commonly used HCC screening guidelines
| AASLD98 | NCCN38 | EASL-EORTC99 | JHS100 | APASL101 | |
|---|---|---|---|---|---|
| Population recommended to undergo screening | Cirrhosis of any etiology | Cirrhosis of any etiology HBV carriers with additional risk factors* |
Cirrhosis of any etiology HBV carriers with active infection or family history of HCC HCV carriers with advanced fibrosis |
Extremely high-risk: cirrhosis due to HBV or HCV High-risk: HBV or HCV, cirrhosis of any other etiology |
Cirrhosis due to HBV or HCV |
| Abdominal US screening frequency | 6 months | 6–12 months | 6 months | Extremely high-risk: 3–4 months High-risk: 6 months |
6 months |
| Serum markers | Not recommended | Not recommended | Not recommended | Recommend: AFP, DCP, and AFP-L3% Extremely high-risk group: every 3–4 months High-risk group: every 6 months |
Recommend AFP |
| Axial imaging for concerning nodules | Four-phase contrast-enhanced CT Gadolinium-enhanced MRI |
Four-phase contrast-enhanced CT Gadolinium-enhanced MRI |
Four-phase contrast-enhanced CT Gadolinium-enhanced MRI |
Four-phase contrast-enhanced CT Gd-EOB-DTP-enhanced MRI |
Four-phase contrast-enhanced CT Gadolinium-enhanced or SPIO MRI |
| CEUS | Not recommended | Not recommended | Not recommended | Sonazoid contrast | Sonazoid or Levovist contrast |
| Accepted methods for diagnosis | Axial imaging | Axial imaging | Axial imaging | Axial imaging | Axial imaging |
| Core biopsy | Core biopsy | Core biopsy | CEUS | CEUS | |
| Core biopsy | Core biopsy |
Notes:
Additional risk factors include HBV carrier with family history of HCC, Asian males ≥40 years, Asian females ≥50 years, and African/North American Blacks with HBV.
Abbreviations: AASLD, American Association for the Study of Liver Diseases; AFP, alpha-fetoprotein; APASL, Asian Pacific Association for the Study of the Liver; CEUS, contrast-enhanced ultrasound; CT, computed tomography; DCP, des-gamma-carboxy prothrombin; EASL-EORTC, European Association for the Study of the Liver – European Organisation for Research and Treatment of Cancer; Gd-EOB-DTP, gadolinium-ethoxybenzyl-diethylentriamine pentaacetic acid; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; JHS, Japan Society of Hepatology; MRI, magnetic resonance imaging; NCCN, National Comprehensive Cancer Network; SPIO, superparamagnetic iron oxide; US, ultrasound.