Management of small hepatocellular carcinoma

In the last years the incidence of hepatocellular carcinoma (HCC) is rising in cirrhotic patients worldwide. Due the impor- tance of early and definite diagnosis of HCC, any nodular lesion detected in patients with chronic liver disease should be con- sidered as suspicious for HCC. The screening and surveillance programs in patients with liver diseases have increased the number of small HCC detected at an early stage, when the therapeutic options available are able to pro- vide benefit. The introduction of new imaging techniques has improved the accuracy of characterizing these nodules. According to the EASL recommendations, contrast-enhanced computed tomography (CT), contrast enhanced ultrasound (US) and magnetic resonance (MR) with different MR-contrast agents are currently used to characterize liver lesions. Imaging guided biopsy is recommended for small nodules or in lesions without typical fea- tures (arterial hypervascularization) in at least two imaging tech- niques. Frequently the differential diagnosis of small nodules is complicated by discordant vascularity and recent studies have also demonstrated the presence of small hypovascular HCC at perfu- sional US and helical CT. At present, different treatment options can be offered to patients with diagnosis of small HCC at an early stage ; percutaneous techniques, surgical resection and liver trans- plantation can provide benefit in properly selected patients. This review describes some critical points regarding the detec- tion, diagnosis and therapeutic management of small nodules of HCC in cirrhotic patients. (Acta gastroenterol. belg., 2006, 69, 230- 235).