title: Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it?
abstract: Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Erroi
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Garuti
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Odaldi
authors.affiliation: Edoardo G Giannini, Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, IRCCS-Azienda Ospedaliera San Martino-IST, 16155 Genova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000191:economics / Q000401:mortality / Q000628:therapy; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography
keywords: Cost-effectiveness; Hepatocellular carcinoma; Screening; Surveillance; Ultrasonography