2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma.
Bottom Line: In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies.Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions.This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
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Mentions: The diagnosis of HCC for liver nodules detected by surveillance is based on noninvasive criteria or pathology (Table 3, Fig. 3). Noninvasive criteria can only be applied to high-risk groups (i.e., HBV/HCV infection and liver cirrhosis) and are based on imaging including dynamic CT, dynamic MRI, and MRI using a hepatocyte-specific contrast agent. Diagnosis should be based on the identification of the typical hallmark of HCC (i.e., hypervascularity in the arterial phase and washout in the portal or delayed phase) for liver nodules ≥1 cm in diameter.45,62,67 One or more imaging techniques are usually recommended for noninvasive diagnosis for these nodules; however, one or more imaging techniques are required in optimal settings (Appendices 5 and 6), whereas two or more are recommended in suboptimal settings for nodules 1–2 cm in diameter.58 In addition, stricter criteria are warranted for the diagnosis of HCC in cases of nodules <1 cm. Diagnosis should be based on the combination of the identification of the typical hallmark of HCC in two or more imaging modalities and increased serum AFP with an increasing trend over time for liver nodules <1 cm in patients with suppressed hepatitis activity.57 Biopsy should be considered for atypical nodules not meeting the noninvasive criteria. Any changes in the size or characteristics of nodules or serum tumor markers should be monitored if noninvasive or pathologic diagnosis is unfeasible for liver nodules in high-risk patients.