What are the recommended surveillance protocols for patients at high risk of developing hepatocellular carcinoma (HCC)?

Recommended surveillance protocols for patients at high risk of developing hepatocellular carcinoma (HCC) include:

• Perform hepatic ultrasound and alpha-fetoprotein (AFP) testing every 6 months in adults with chronic hepatitis B who have significant fibrosis (METAVIR stage ≥ F2 or Ishak stage ≥ 3) or cirrhosis.
• Consider 6-monthly surveillance with ultrasound and AFP in people without significant fibrosis or cirrhosis if they are older than 40 years, have a family history of HCC, and have HBV DNA ≥ 20,000 IU/ml.
• Do not offer surveillance in people without significant fibrosis or cirrhosis who have HBV DNA < 20,000 IU/ml and are younger than 40 years.
• For people with cirrhosis not related to hepatitis B virus infection, offer ultrasound (with or without AFP measurement) every 6 months as surveillance for HCC.
• In patients with cirrhosis and chronic hepatitis B, the need for HCC surveillance is a specialist decision based on fibrosis stage, age, family history, and HBV DNA levels.
• Do not offer HCC surveillance to people receiving end-of-life care.

These protocols aim to detect HCC early in high-risk populations to improve outcomes through timely intervention.

References: Surveillance every 6 months by ultrasound and AFP in chronic hepatitis B with significant fibrosis or cirrhosis ¹. Consider surveillance in those >40 years with family history and high HBV DNA ¹. No surveillance if low HBV DNA and younger than 40 ¹. Ultrasound ± AFP every 6 months in cirrhosis without HBV ³. Specialist decision for cirrhosis with HBV ⁵. No surveillance in end-of-life care ³.