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Cirrhosis surveillance — ESEGH MCQ

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EasyHepatologyCirrhosis surveillanceESEGH

A 40-year-old woman has compensated cirrhosis caused by autoimmune hepatitis. She has an ECOG performance status of 0 and no comorbidity that would preclude hepatocellular carcinoma treatment. Her platelet count is 110 × 10^9/L and bilirubin is 21 micromol/L. Liver ultrasound 7 months ago showed no focal lesion. What is the most appropriate next step in her hepatocellular carcinoma surveillance?

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Correct answer: C — Arrange liver ultrasound and serum AFP measurement every 6 months

The correct answer is C. Cirrhosis due to autoimmune hepatitis confers an indication for hepatocellular carcinoma surveillance while the patient remains suitable for cancer-directed treatment. Current BSG guidance recommends liver ultrasound with serum AFP every 6 months; her last scan was 7 months ago, so surveillance should be arranged now. Compensated disease is not a reason to defer surveillance, because early detection offers the greatest opportunity for potentially curative treatment. AFP alone has inadequate sensitivity and specificity and should not replace imaging. CT is used to characterise suspicious lesions rather than as routine 3-yearly surveillance, because of radiation, contrast exposure and inappropriate surveillance frequency. Serial liver biopsy has no role in HCC surveillance.

Reference: British Society of Gastroenterology, British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults, section: Surveillance for hepatocellular carcinoma, 2024. https://www.bsg.org.uk/getmedia/07619716-2735-45d5-804e-9f83edfa8691/HCC-gutjnl-2023-331695-full.pdf