Diagnosis of hepatocellular carcinoma.

More than 90% of cases of hepatocellular carcinoma occur on the background of chronic liver disease. Its diagnosis should therefore be based on six-month ultrasound screening, which should be started in these patients. The positive diagnosis of hepatocellular carcinoma is based on its vascularization examined on dynamic CT or MRI images after contrast enhancement. Arterial hypervascularization followed by a washout from the lesion in the portal and/or late phases on a background of cirrhosis provides a positive diagnosis of HCC without histology for nodules over a centimeter in size (international guidelines). Any other appearances require needle biopsy of the nodule and extra-nodular area to confirm the diagnosis. The local staging assessment predominantly involving portal invasion and the general patient assessment should be combined with assessment of the underlying liver disease to guide the treatment decision. The information obtained should be contained in as standardized a report as possible with all of the information required for patient management.