Background/Aims Surveillance for hepatocellular carcinoma (HCC) with ultrasound in high-risk populations is generally believed to improve opportunities for treatment. However, tumors are still missed due to various factors. This study explores success versus failure of HCC surveillance. Methods: This is a retrospective study of 1,125 HCC cases. Categories considered for successful detection were largest tumor ≤3.0 cm, single tumors ≤3.0 cm and ≤2.0 cm, and adherence to Milan criteria. Examined factors were age <60 years, gender, rural residence, body-mass index (BMI), hepatitis infection, smoking, diabetes, hyperlipidemia, cirrhosis, ascites, and Model for End-Stage Liver Disease <10. Results: HCC was found on surveillance in 257 patients with a mean tumor size of 3.17 cm; multiple tumors were seen in 28% of cases, bilateral tumors in 7.4%, and vascular invasion in 3.7%. Surveillance was successful in 61.5% of cases involving a largest tumor ≤3.0 cm, with BMI ≥35 negatively affecting detection (odds ratio [OR] 0.28, P=0.014) and cirrhosis positively affecting detection (OR 2.31, P=0.036). Ultrasound detected 19.1% of single tumors ≤2.0 cm with ascites improving the detection rate (OR 3.89, P=0.001). Finally, adherence to Milan criteria occurred in 75.1% of cases, revealing negative associations with diabetes (OR 0.48, P=0.044 and male gender (OR 0.49, P=0.08). Conclusions: Although surveillance is recommended for HCC, not all surveillance ultrasound are ideal. Tumor detection can depend on gender, BMI, diabetes, cirrhosis, and ascites and is achieved in 19.1–75% of cases depending on the definition of success. Closer follow-up or additional imaging might be necessary for some patient subgroups.
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Citations to this article as recorded by
Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment Soo Young Hwang, Pojsakorn Danpanichkul, Vatche Agopian, Neil Mehta, Neehar D. Parikh, Ghassan K. Abou-Alfa, Amit G. Singal, Ju Dong Yang Clinical and Molecular Hepatology.2025; 31(Suppl): S228. CrossRef
Abbreviated MRI-Based Surveillance Strategies for Early Hepatocellular Carcinoma Detection Hyo Jung Park, Dong Wook Kim, Won-Mook Choi, So Yeon Kim Journal of the Korean Society of Radiology.2025; 86(3): 335. CrossRef
Proper assessment and prognostication of patients with hepatocellular carcinoma Edoardo G. Giannini Clinical Liver Disease.2024;[Epub] CrossRef
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From NAFLD to HCC: Advances in noninvasive diagnosis Qinchen Xu, Maoxiao Feng, Yidan Ren, Xiaoyan Liu, Huiru Gao, Zigan Li, Xin Su, Qin Wang, Yunshan Wang Biomedicine & Pharmacotherapy.2023; 165: 115028. CrossRef
Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high‐risk patients Hyo Jung Park, So Yeon Kim, Amit G. Singal, So Jung Lee, Hyung Jin Won, Jae Ho Byun, Sang Hyun Choi, Takeshi Yokoo, Min‐Ju Kim, Young‐Suk Lim Liver International.2022; 42(9): 2080. CrossRef
A multi‐analyte cell‐free DNA–based blood test for early detection of hepatocellular carcinoma Nan Lin, Yongping Lin, Jianfeng Xu, Dan Liu, Diange Li, Hongyu Meng, Maxime A. Gallant, Naoto Kubota, Dhruvajyoti Roy, Jason S. Li, Emmanuel C. Gorospe, Morris Sherman, Robert G. Gish, Ghassan K. Abou‐Alfa, Mindie H. Nguyen, David J. Taggart, Richard A. V Hepatology Communications.2022; 6(7): 1753. CrossRef
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Surveillance of hepatocellular carcinoma: is only ultrasound enough? Woo Kyoung Jeong Clinical and Molecular Hepatology.2017; 23(3): 222. CrossRef
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