Früherkennung des hepatozellulären Karzinoms

Screening for hepatocellular carcinoma (HCC) in risk groups increases the percentage of small HCCs which are potentially eligible for curative treatment options. The present method of choice is 6 monthly ultrasound examinations of the liver. All suspect lesions greater than 1 cm in diameter should undergo further investigation by contrast-enhanced imaging techniques including ultrasound, CT and MRI, if the patient potentially qualifies for a (curative) treatment. In lesions greater than 2 cm one contrast-enhanced technique is sufficient to make the diagnosis of HCC. Lesions 1–2 cm in diameter should be diagnosed by two techniques showing a HCC-specific vascular profile. Any atypical imaging pattern should trigger a diagnostic evaluation by (guided) biopsy of the suspect lesion. If imaging and biopsy remain inconclusive the follow-up may be intensified and early re-biopsy can be considered. Very small lesions <1 cm require a close 3-monthly ultrasound examination for up to 2 years if stable or regressive, in the case of a progressive disease course further specific HCC diagnosis should be initiated as outlined.