Surveillance testing for hepatocellular carcinoma (HCC) in adults with chronic hepatitis B

Surveillance testing for hepatocellular carcinoma (HCC) in adults with chronic hepatitis B

• 6-monthly surveillance should be performed for HCC by hepatic ultrasound and alphafetoprotein testing in people with significant fibrosis (METAVIR stage greater than or equal to F2 or Ishak stage greater than or equal to 3) or cirrhosis
• in people without significant fibrosis or cirrhosis (METAVIR stage less than F2 or Ishak stage less than 3), consider 6-monthly surveillance for HCC if the person is older than 40 years and has a family history of HCC and HBV DNA greater than or equal to 20,000 IU/ml
• surveillance for HCC should not be offered in people without significant fibrosis or cirrhosis (METAVIR stage less than F2 or Ishak stage less than 3) who have HBV DNA less than 20,000 IU/ml and are younger than 40 years

Notes:

• adults with a transient elastography score greater than or equal to 11 kPa are very likely to have cirrhosis and confirmation by liver biopsy is not needed
• the degree of fibrosis cannot be accurately predicted in adults with a transient elastography score between 6 to 10 kPa. Some people may choose to have a liver biopsy in these circumstances to confirm the extent of liver disease
• adults with a transient elastography score less than 6 kPa are unlikely to have significant fibrosis.

Reference:

• 1) NICE (October 2017). Hepatitis B (chronic) Diagnosis and management of chronic hepatitis B in children, young people and adults