NAFLD and HCC screening: AGA issues guidelines

  • Loomba R & al.
  • Gastroenterology
  • 29 Jan 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Description

  • Clinical practice update from American Gastroenterological Association (AGA).

Key points

  • 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.