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Clinical Practice Update

Screening and surveillance for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease (NAFLD)

A guide to risk assessment of hepatocellular carcinoma (HCC) among patients with nonalcoholic fatty liver disease (NAFLD) and appropriate screening and surveillance strategies.

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Best practice advice

1. Screening for hepatocellular carcinoma should be considered in all patients with cirrhosis due to nonalcoholic fatty liver disease (NAFLD).

2. Patients with NAFLD with noninvasive markers showing evidence of advanced liver fibrosis or cirrhosis should be considered for hepatocellular carcinoma screening.

3. Patients with NAFLD in the absence of advanced liver fibrosis should not be routinely considered for hepatocellular carcinoma screening.

4. Adequacy of ultrasound in assessing the liver parenchyma for mass lesions should be documented when used for hepatocellular carcinoma screening in patients with cirrhosis due to NAFLD.

5. When the quality of ultrasonography is suboptimal for screening of hepatocellular carcinoma (eg, due to obesity) future screening should be performed by either computed tomography or magnetic resonance imaging scan, with or without α-fetoprotein, every 6 months.

6. Patients with cirrhosis due to NAFLD should be counseled on abstaining from alcohol drinking and tobacco smoking.

7. Optimal management of diabetes and dyslipidemia through lifestyle modification and pharmacotherapy is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for hepatocellular carcinoma.

8. Optimal management of obesity through lifestyle modification, pharmacotherapy or endoscopic or surgical bariatric procedures is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for hepatocellular carcinoma.

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