The clear connection between the existence of liver cirrhosis and occurrence of HCC means that early detection
and monitoring of patients at risk is particularly important. It can be assumed that 90% of all HCC arise in patients with liver cirrhosis (13). At the same time, the prognosis of patients whose HCC was detected on screening is much better than the survival of those in whom HCC was diagnosed after the occurrence of symptoms (14). A randomized controlled study of patients with chronic hepatitis B showed that ultrasound examination lowered the mortality from 80% to 37% (15). In contrast, investigation of at-risk populations with an alpha-fetoprotein (AFP) tumor marker alone had sensitivity of only 55% with specificity of 87% (16). By comparison, ultrasound examination in an HCC screening program led to specificity of over 90%
with sensitivity of between 60% and 90% (17).
Because of the low sensitivity the guideline does not
recommend regular measurement of AFP, but restricts
the screening examination to half-yearly ultrasound
controls. Abdominal sonography should be performed
every 6 months in patients with