What are the criteria for referring a patient with suspected HCC to a specialist for further evaluation?

Criteria for referring a patient with suspected hepatocellular carcinoma (HCC) to a specialist:

• Refer any person diagnosed with cirrhosis to a hepatologist or gastroenterologist with an interest in hepatology for specialist assessment, as they are at increased risk of HCC. This includes those diagnosed by transient elastography or imaging, if not already under specialist care ¹,⁵.
• Arrange urgent referral or specialist assessment if there are signs of decompensated liver disease (such as ascites, encephalopathy, or gastrointestinal hemorrhage), which may be associated with advanced liver disease and HCC ¹,⁵.
• In people with chronic hepatitis B, refer all adults who are hepatitis B surface antigen (HBsAg) positive to a hepatologist or gastroenterologist with an interest in hepatology, including those undergoing surveillance for HCC with hepatic ultrasound and alpha-fetoprotein testing ⁴.
• Perform 6-monthly surveillance for HCC by hepatic ultrasound and alpha-fetoprotein testing in people with significant fibrosis (METAVIR stage ≥F2 or Ishak stage ≥3) or cirrhosis; consider referral if surveillance detects suspicious lesions ⁴.
• Refer patients with suspected HCC detected on surveillance imaging or with clinical suspicion for further specialist evaluation and management ¹,⁴.

In summary, referral to a specialist for suspected HCC is indicated in patients with cirrhosis or significant fibrosis, those with chronic hepatitis B infection under surveillance, and any patient with signs of decompensated liver disease or suspicious imaging findings ¹,⁴,⁵.