Blood-based HCC surveillance to replace six-monthly ultrasound

The idea is to replace six-monthly ultrasound surveillance for hepatocellular carcinoma in cirrhosis with a blood test, using cell-free DNA methylation panels or the GALAD score that incorporates alpha-fetoprotein. Ultrasound misses much early HCC in obese and steatotic livers, whereas blood is unaffected by body habitus and can be posted, and poor adherence is the biggest failure of current surveillance. The hypothesis is that blood surveillance in fatty-liver cirrhosis detects more early-stage HCC than ultrasound at an acceptable false-positive rate, increasing curative-intent treatment. The test is a randomised or paired-design trial with early-stage detection and curative treatment as endpoints; it addresses the bottleneck that the hardest cancers are found late.