ideasIdea
Blood-based HCC surveillance to replace six-monthly ultrasound
A blood test (methylation, GALAD) that finds liver cancer early in people with cirrhosis, especially those with fatty liver where ultrasound fails.
Ultrasound misses a third of early HCC in obese and steatotic livers. cfDNA methylation panels and the GALAD score reach sensitivities of 70-85% for early-stage disease in case-control studies; prospective surveillance cohorts are underway.
Hypothesis
Six-monthly blood surveillance detects more early-stage HCC than ultrasound in MASLD cirrhosis at acceptable false-positive rates, increasing curative-intent treatment.
Rationale
Blood is unaffected by body habitus and can be mailed; adherence is the biggest failure of current surveillance.
What would test it
Randomised or paired-design surveillance trial with early-stage detection and curative treatment rate as endpoints.
Maturity
early clinical