DIAGNOSIS OF HCC

1. A patient with underlying liver disease (ie, cirrhosis, chronic viral hepatitis)
2. A rising serum alfa-fetoprotein (AFP) level
3. A lesion which is hypervascular, has increased T2 signal intensity, or demonstrates venous invasiona in CT scan of the liver and/or magnetic resonance imaging (MRI)

If the diagnostic imaging studies are less definitive, follow-up imaging may clarify the diagnosis; dysplastic nodules typically remain stable, while an enlarging dominant lesion more likely represents a HCC. Even stable nodules require close follow-up, since livers containing dysplastic nodules are at high risk to develop HCC in the future [29]. Molecular genetic studies have shown promise in identifying a molecular signature that can differentiate dysplastic nodules from HCC, but more studies are needed [30].

For non-cirrhotic patients, the diagnosis of HCC should be considered for any hepatic mass that is not clearly a hemangioma or focal nodular hyperplasia, especially if it is hypervascular. In the absence of specific clues to the diagnosis, biopsy may be appropriate.