System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Consensus Statement Practice Guideline Epublish

PubMed: 42690308 DOI: 10.1590/0102-672020260000035e1964

Diagnosis, clinical assessment, and staging of hepatocellular carcinoma: a Brazilian multidisciplinary consensus.

Arq Bras Cir Dig 39:e1964

Authors: Felipe José Fernández Coimbra, André Luís de Godoy, Paulo Henrique de Sousa Fernandes, Heládio Feitosa Neto, Rodrigo Nascimento Pinheiro, Ilka de Fátima Santana Ferreira Boin, Wellington Andraus, Francisco Tustumi, Paulo Cezar Galvão do Amaral, Carlos Eduardo Brandão Mello, Alexcia Camila Braun, Maria Ignez Braghiroli, Luis César Bredt, Carla Caparroz, Flair José Carrilho, Guilherme Moura Cunha, Alessandro Landskron Diniz, Daniel Neves Forte, José Huygens Parente Garcia, Tércio Genzini, Mauro Monteiro Correia, Cássio Virgílio Cavalcante de Oliveira, Antonio Nocchi Kalil, Agnaldo Soares Lima, Guilherme Lopes Pinheiro Martins, Cristina Melo Rocha, Marcos Roberto de Menezes, Joaquim Maurício da Motta-Leal-Filho, Munir Murad Júnior, Renata D'Alpino Peixoto, Rafael Soares Pinheiro, Marcelo Bruno Rezende, Héber Salvador de Castro Ribeiro, Mario Rino Martins, Duilio Reis da Rocha Filho, Arthur Accioly Rosa, Luiz Arnaldo Szutan, Orlando Jorge Martins Torres, Luiz Augusto Carneiro D'Albuquerque, Ângelo Alves de Mattos, Anelisa Kruschewsky Coutinho, Paulo Herman, Alexandre Ferreira Oliveira

Affiliations

  • A.C. Camargo Cancer Center, HPB & Upper GI Oncology Reference Center, Abdominal Surgery, Department of Surgical Oncology - São Paulo (SP), Brazil.
  • Universidade Federal de Uberlândia, Department of Surgical Oncology - Uberlândia (MG), Brazil.
  • Instituto do Câncer do Ceará, Department of Surgical Oncology - Fortaleza (CE), Brazil.
  • Hospital de Base do Distrito Federal, Department of Surgical Oncology - Brasília (DF), Brazil.
  • Universidade Estadual de Campinas, Department of Surgery - Campinas (SP), Brazil.
  • Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil.
  • São Rafael Hospital/Rede D'Or Hospital Group, Department of Surgery of the Upper Digestive System - Salvador (BA), Brazil.
  • Universidade Federal do Estado do Rio de Janeiro, Department of Internal Medicine - Rio de Janeiro (RJ), Brazil.
  • Instituto do Câncer do Estado de São Paulo, Department of Oncology - São Paulo (SP), Brazil.
  • Universidade Estadual do Oeste do Paraná, Department of Surgical Oncology and Hepatobiliary Surgery - Cascavel (PR), Brazil.
  • Hospital Beneficência Portuguesa de São Paulo, Department of Radiology - São Paulo (SP), Brazil.
  • University of Washington, Department of Radiology - Seattle, United States of America.
  • Universidade de São Paulo, Emergency Department - São Paulo (SP), Brazil.
  • Universidade Federal do Ceará, Walter Cantídio University Hospital, Liver Transplant Unit, Department of Surgery - Fortaleza (CE), Brazil.
  • Leforte Hospital, Pancreas and Kidney Transplant Program - São Paulo (SP), Brazil.
  • Instituto Nacional de Câncer, Department of Abdominopelvic Surgery - Rio de Janeiro (RJ), Brazil.
  • Universidade Federal da Paraíba, Department of Surgery - João Pessoa (PB), Brazil.
  • Irmandade Santa Casa de Misericórdia de Porto Alegre, Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation - Porto Alegre (RS), Brazil.
  • Universidade Federal de Minas Gerais, Department of Surgery - Belo Horizonte (MG), Brazil.
  • Instituto do Câncer do Estado de São Paulo, Department of Radiology - São Paulo (SP), Brazil.
  • Universidade Federal do Amazonas, Department of Gastroenterology - Manaus (AM), Brazil.
  • Universidade de São Paulo, Department of Radiology - São Paulo (SP), Brazil.
  • Universidade Federal de Minas Gerais, Department of Oncology - Belo Horizonte (MG), Brazil.
  • University of British Columbia, Department of Medical Oncology - Vancouver, Canada.
  • Hospital Israelita Albert Einstein, Department of Health Sciences - São Paulo (SP), Brazil.
  • Hospital de Câncer de Pernambuco, Department of Oncological Surgery - Recife (PE), Brazil.
  • Universidade Federal do Ceará, Department of Oncology - Fortaleza (CE), Brazil.
  • Oncoclínicas Salvador and Hospital Santa Izabel, Department of Radiation Oncology - Salvador (BA), Brazil.
  • Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Surgery - São Paulo (SP), Brazil.
  • Universidade Federal do Maranhão, Department of Gastrointestinal Surgery - São Luís (MA), Brazil.
  • Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Gastroenterology and Hepatology - Porto Alegre (RS), Brazil.
  • Rede Mater Dei, Department of Oncology - Salvador (BA), Brazil.
  • Universidade Federal de Juiz de Fora, Department of Surgery - Juiz de Fora (MG), Brazil.

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with a rising incidence largely driven by chronic liver disease. Accurate diagnosis and appropriate clinical assessment at the time of presentation are essential, as therapeutic strategies and prognosis depend on tumor burden, liver function, portal hypertension, and patient performance status.

AIM

To develop evidence-based, multidisciplinary recommendations to guide the diagnosis, clinical assessment, and staging of patients with HCC.

METHODS

This consensus was developed by 43 experts from surgical oncology, hepatology, clinical oncology, radiology, interventional radiology, pathology, liver transplantation, gastroenterology, radiation oncology, and palliative care, under the coordination of the Brazilian Society of Surgical Oncology and 13 collaborating national medical societies. A scientific steering committee predefined clinically relevant questions addressing radiological and histopathological diagnosis, clinical assessment, diagnostic work-up, management of patients at the time of HCC diagnosis, and staging. These questions were discussed and refined in multidisciplinary meetings and submitted to structured voting rounds.

RESULTS

The panel formulated 18 recommendations covering key aspects of HCC evaluation, including standardized application of Liver Imaging Reporting and Data System (LI-RADS®) for imaging-based diagnosis, management of indeterminate lesions, indications for biopsy, histopathological classification and reporting, immunohistochemical markers, assessment of hepatic function and portal hypertension, staging systems, diagnostic work-up, and the role of multidisciplinary care. The recommendations emphasize integration of imaging findings with liver-related factors and clinical context to support individualized decision-making.

CONCLUSIONS

This multidisciplinary consensus provides practical, evidence-based recommendations for the diagnosis, clinical assessment, and staging of HCC. By promoting standardized diagnostic practices while reinforcing comprehensive patient evaluation and multidisciplinary management, this document aims to improve diagnostic accuracy, optimize treatment selection, and support safe care.

MeSH

Hypertension, Carcinoma, Hepatocellular, Neoplasms, Liver, Radiology, Hypertension, Portal, Work, Diagnosis, Therapeutics, Radiology, Interventional