Screening for Hepatocellular Carcinoma in Viral Liver Disease: Is Ultrasound Enough?

HBV and HCV are major causes of liver disease that predispose to the development of hepatocellular carcinoma (HCC). Surveillance in these patients strives to detect tumours at an early stage in order to reduce mortality. Ultrasound is the most widely used radiological test for HCC surveillance, although it is highly operator dependent and has limited sensitivity when used alone. Although alpha-fetoprotein (AFP) is also suboptimal in isolation, it can increase the number of early-stage tumours when used in combination with ultrasound. Other radiological and serological tests have not yet been adequately studied as surveillance tests for routine use in clinical practice. The combination of ultrasound and AFP at 6-month intervals is cost-effective and currently the best-supported surveillance test for HCC.