5. Diagnostic algorithm of hepatocellular carcinoma

Nowadays, the classic diagnostic algorithm of HCC (see Figure 1) includes the evaluation of risk factors in a given patient to assess the need for surveillance. Cirrhotic patients are referred to ultrasound examination once per 6 months. Suspicious nodules are further evaluated by CT and MRI. Characteristic findings by CT and MRI including arterial hypervascularisation represent the basis of non-invasive diagnostics. In controversial and non-cirrhotic cases, biopsy is indicated that might need supplementation by immunohistochemistry according to the morphological features. Innovations are expected in the field of miRNA-based liquid biopsy to support radiological diagnosis, addition of SIR assessment and miRNA profile to select the optimal treatment, e.g. possibly broadening Milan criteria (see also chapter "Innovative Blood Tests for Hepatocellular Carcinoma: Liquid Biopsy and Evaluation of Systemic Inflammatory Reaction"), and novel immunohistochemical markers for cases that still remain ambiguous.
