| Surveillance for hepatocellular carcinoma is recommended in at-risk patients, including those with cirrhosis, and has been associated with improved early tumor detection and overall survival. However, HCC epidemiology is shifting from a viral-hepatitis predominant disease to an increasing number of cases related to non-alcoholic steatohepatitis (NASH), and most studies demonstrating surveillance benefits included few, if any, patients with NASH. There are potential challenges for HCC surveillance in patients with NASH cirrhosis that must be addressed for HCC surveillance to achieve maximal benefits including difficulty recognizing the at-risk patient population and lower image quality and sensitivity of surveillance ultrasound for early tumor detection. Further, increased issues with indeterminate exams may increase screening-related physical harms from subsequent diagnostic evaluation. In this session, we will discuss challenges with HCC surveillance in the 21st century as well as potential steps to address them. |
