A New Milestone in Hepatocellular Carcinoma Surveillance: Clinical Validation of the 2023 AASLD Guidance

Surveillance for hepatocellular carcinoma (HCC) has been suffered from limited sensitivity of US for early stage HCC screening (1).The prospective multicenter study by Cheng et al. (2) represents practical and timely validation of the 2023 American Association for the Study of Liver Diseases (AASLD) guidance for HCC surveillance.The updated surveillance algorithm (AASLD v2023) incorporated US visualization score C (VIS-C, poor visualization), increasing alpha-fetoprotein (AFP) levels, and lesion growth.The study was to assess the performance of AASLD v2023 for HCC detection in comparison to Liver Imaging Reporting and Data System (LI-RADS) v2017and AASLD v2018 in participants at high risk of HCC (3, 4).In 953 participants, AAS-LD v2023 achieved 94% sensitivity and 99.6% negative predictive value (NPV) for HCC detection, significantly outperforming US LI-RADS v2017 (60% sensitivity, 97.6% NPV) and AASLD v2018 (76% sensitivity, 98.5% NPV) (4).Specificity was lower