Clin Mol Hepatol.  2019 Dec;25(4):335-343. 10.3350/cmh.2019.0010.

Detect or not to detect very early stage hepatocellular carcinoma? The western perspective

  • 1Division of Digestive and Liver Diseases, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
  • 2Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA, USA.
  • 3Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
  • 4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.


Very early stage hepatocellular carcinoma (HCC) is defined as a single tumor with the largest diameter of the lesion measuring 2 cm or less according to Barcelona Liver Cancer staging system. Detection of very early stage HCC is clinically important as it confers an excellent prognosis with the 5-year survival rates over 60 to 80% after patients receive curative treatments. While diagnosing HCC at a very early stage is crucial, it is technically challenging and may come with the physical or psychosocial harms related to diagnostic tests. It is further complicated by the fact that patients with very early stage HCC are not prioritized for liver transplant (LT) in the United States organ allocation system. When LT-eligible patients present with an indeterminate lesion measuring between 1 and 2 cm on the multiphasic computed tomography or magnetic resonance imaging, clinicians often observe patients carefully until the lesion grows up to 2 cm so that patients can be eligible to receive a Model for End-Stage Liver Disease (MELD) exception score for HCC in the United States. The European guideline recommends a routine biopsy of such lesion. In conclusion, attempting to detect very early stage HCC is difficult to achieve and controversial. Clinicians should take into account of the risk and the benefit of diagnostic tests, LT candidacy of patients and the local organ allocation system.


Liver cancer; Hepatocellular cancer; Diagnosis; Hepatocellular carcinoma (HCC)

MeSH Terms

Carcinoma, Hepatocellular*
Diagnostic Tests, Routine
Liver Diseases
Liver Neoplasms
Magnetic Resonance Imaging
Survival Rate
United States
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