Review worldwide approaches to HCC diagnosis, highlighting similarities and differences in algorithms. Provide an overview of updates to LI-RADS/AASLD, updates to literature, and highlight future directions based on current gaps in knowledge.
There are differences in diagnostic algorithms for HCC around the world. These stem mostly from different epidemiology of liver disease and mainstay therapies in different geographical regions. In regions where cirrhosis is the main risk factor for HCC, transplantation tends to be the dominant curative therapy. In the context of transplantation, diagnostic specificity must be high to avoid false positive diagnosis and unjust organ allocation. In other regions where Hepatitis B viral infection is the main risk factor for HCC (i.e. even in the absence of cirrhosis), resection is a more accessible curative therapy. In the context of resection, diagnostic sensitivity is desired to detect all disease for either complete resection or avoidance of futile surgery.
While these geographic differences in the balance of specificity and sensitivity exist, the basic features of HCC are primarily agreed upon: Arterial phase hyperenhancement, washout appearance, and growth. This talk will provide a review of recent updates to imaging diagnosis (focus on LI-RADS/AASLD), highlight differences between LI-RADS and other systems, and demonstrate the algorithmic approach to diagnosis of HCC. Additionally, we will discuss the role of biopsy and MDD and highlight future directions and gaps in knowledge that may inform changes in the system.
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