Monitoring
Patients with lesions <1 cm on initial screening ultrasound are typically monitored with a further ultrasound and alpha fetoprotein (AFP) every 3-6 months.[7] If the lesion demonstrates no growth after two or more follow-up ultrasound examinations, these patients may revert to routine surveillance (ultrasound and AFP every 6 months).[7]
Patients with treated hepatocellular carcinoma (HCC) should be followed up with dynamic contrast imaging (multiphasic computed tomography [CT] or magnetic resonance imaging [MRI]) every 3-4 months for the first 2 years. Imaging interval may be increased after 2 years in recurrence-free patients.[59] In patients with elevated serum AFP at diagnosis, serial monitoring every 3-4 months post-treatment may allow for earlier detection of recurrence.
For patients undergoing liver transplantation for HCC, surveillance with serum AFP and contrast-enhanced CT or MRI of the chest, abdomen, and pelvis every 6-12 months is recommended. In patients with high-risk features on explant pathology (such as microvascular invasion or tumour burden beyond standard criteria) more frequent surveillance at 3- to 4-month intervals may be appropriate, especially in the first 2 years post-transplant.[7] These recommendations align with the 2023 American Association for the Study of Liver Diseases guidance and the 2024 International Liver Transplantation Society-International Liver Cancer Association consensus statement, which support a risk-adapted surveillance approach and emphasise the role of validated recurrence models rather than a one-size-fits-all protocol.[7][168]
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