OBJECTIVES : Early detection and screening of HCC in highly susceptible patients is of high importance and almost every guideline for the management of HCC provides recommendation for screening and/or surveillance in patients with increased risk for HCC

METHODS : The review summarizes differences in nine major clinical practice guidelines evaluated for the management of HCC including AASLD, NCCN, ESMO-ESDO, EASL-EORTC, BSG, NICE, JSH, Chinese, and Korean Guidelines

RESULTS : The AASLD, Korean, and EASL-EORTC guidelines recommended that ultrasonography (US) be used as a screening test but not as a confirmatory test, as US may reveal a nodule but cannot characterize nodules. Determination of AFP level for diagnosis (for <1 cm and >1 cm nodule size) is only recommended by the recent guidelines issued in the Asian countries such as Chinese and Korean guidelines. Ultrasonography and measurements of AFP (α-fetoprotein)/ AFP-L3 (AFP Lectin fraction)/ DCP (Des-gamma carboxyprothrombin) also called as PIVKA-II (protein induced by vitamin K absence or antagonist II)) every 3 to 4-6 months and CT/MRI every 6 to 12 months (optional) have been recommended by JSH guidelines for very high risk group patients. It also recommends measurement of two or more markers for HCC diagnosis/screening. Abdominal ultrasonography with α-fetoprotein test 6 monthly has been recommended by the BSG and Chinese guidelines. Japanese guidelines provide the most stringent requirements for screening, recommending ultrasonography along with measurements of serum AFP/PIVKA and dynamic CT/MRI performed concurrently every 3 to 4 months for patients susceptible to high risk. AASLD and NCCN (USA) provide most comprehensive list of patients selected for screening/surveillance with some similarities to rest of the guidelines

CONCLUSIONS : Guidelines across the Western and Asian countries differ in terms of recommendations, technique, and interval of screening