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Diagnostic workup of a liver mass in a patient with chronic liver disease

for Health Care Providers

Table 11. Diagnostic workup of a liver mass in a patient with chronic liver disease

Back to Cirrhosis Recommendations

CAT, computerized axial tomography; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging; US, ultrasound.
Mass <1 cmDiagnosisLow likelihood of being HCC, therefore no specific diagnostic tests
Follow-upRepeat imaging study every 3 months
  • If no growth in 1-2 years, no HCC; continue screening every 6 months
  • If growth, treat as HCC
Mass 1-2 cmDiagnosisTwo dynamic imaging studies (US, CAT scan, or MRI)
  • Both with typical vascular pattern
    • Treat as HCC
  • One typical and the other atypical
    • Consider biopsy of mass
  • Both atypical
    • Consider biopsy of mass vs. close follow-up
Follow-up after biopsyBiopsy confirms HCC
  • Treat as HCC
Non-diagnostic
  • Repeat imaging study every 3 months:
    • If no growth in 1-2 years --> no HCC
    • If growth, treat as HCC
Mass >2 cmDiagnosisOne dynamic imaging study (US, CAT scan, or MRI)
  • Typical vascular pattern
    • Treat as HCC
  • Atypical vascular pattern
    • Biopsy of mass
Follow-up after biopsyBiopsy confirms HCC
  • Treat as HCC
Non-diagnostic
  • Repeat imaging study every 3 months:
    • If no growth in 1-2 years --> no HCC
    • If growth, treat as HCC

From Management and Treatment of Patients with Cirrhosis and Portal Hypertension