Toward Precision Hepatocellular Carcinoma Surveillance: Standardizing Ultrasound Visualization and Optimizing Biomarker Integration
We read with interest the randomized controlled trial by Hirode et al1 evaluating whether adding serum biomarkers (α-fetoprotein [AFP], AFP-L3, and des-γ-carboxyprothrombin) to semiannual abdominal ultrasound (US) improves the detection of early-stage hepatocellular carcinoma (HCC) in high-risk patients. In 1208 randomized participants, the authors observed no difference in early-stage detection between US alone and US plus biomarkers (hazard ratio, 0.81; 95% confidence interval, 0.47–1.40), yet they documented biomarker-only HCC diagnoses despite negative results on US—an important, practice-relevant signal.
