From Biomarkers to Precision Surveillance: A Socio-Technical Review of Non-Invasive Hepatocellular Carcinoma Screening in Cirrhosis

This review examines how non-invasive biomarker technologies are reshaping hepatocellular carcinoma (HCC) surveillance in cirrhosis when considered not only as diagnostic tools but also as socio-technical interventions. A structured narrative review was developed from a targeted full-text corpus covering biomarkers, precision surveillance, cost-effectiveness, surveillance harms, and disparities in access and outcomes. The literature was coded thematically across five domains: biomarker technologies, precision surveillance models, economic value, patient burden, and equity and implementation. The reviewed evidence shows that surveillance is moving from a one-size-fits-all ultrasound-based model toward hybrid, risk-stratified systems that combine blood-based biomarkers, algorithmic scores, and selective advanced imaging. Composite scores such as GALAD and HES V2.0 improve early-stage detection compared with single markers, while recent modeling studies suggest that biomarker-based or precision surveillance can be cost-effective under realistic assumptions about test performance, adherence, and price. However, adoption is constrained by assay standardization, reimbursement, false-positive workup, psychological and financial harms, and persistent disparities related to insurance, mental health, transportation, language, and digital access. The main conclusion is that the future of HCC screening is not simply a better biomarker but a better surveillance system. Research and policy should therefore evaluate analytic performance together with workflow fit, patient acceptability, equity, governance, and real-world implementation.