- In patients with nonalcoholic fatty liver disease (NAFLD), noninvasive markers can help determine need for screening and surveillance for hepatocellular carcinoma (HCC).
- Ultrasound, if used, must offer high-quality images, or another imaging modality should replace it.
Why this matters
- NAFLD affects 1 in 4 people and is on the rise.
- Many go on to develop HCC, the second leading cause of cancer death globally.
- Clinical practice update from American Gastroenterological Association (AGA).
- All patients with NAFLD-associated cirrhosis should be considered for HCC screening.
- Incidence in this population exceeds 1.5%/year.
- Those with NAFLD and noninvasive markers of advanced liver fibrosis or cirrhosis should be considered for HCC screening.
- These include labs, demographic factors, imaging, and risk scores such as Fibrosis-4.
- Combine ≥2 testing modalities.
- Do not routinely screen NAFLD patients who lack advanced liver fibrosis.
- When screening for HCC with ultrasound, document adequacy; if suboptimal, screen every 6 months with CT or MRI and possibly alpha-fetoprotein.
- Advise NAFLD patients with cirrhosis to avoid alcohol, tobacco, e-cigarettes.
- Patients with NAFLD and advanced liver fibrosis should use lifestyle modification and medication to manage diabetes and dyslipidemia, if present.
- Patients with NAFLD, advanced liver fibrosis, and obesity should also manage the latter, including with bariatric surgery if necessary.