3.1 Specialist diagnostic work-up

3.1 Specialist diagnostic work-up

The treatment team, after taking a thorough medical history and making a thorough medical examination of the patient, should undertake the following investigations under the guidance of a specialist.

Radiological imaging is primarily used to diagnose patients with cirrhosis or at high risk for HCC (e.g. chronic HBV), and biopsy is only required if there is still uncertainty.

The following sequence of investigations is suggested:

  • four-phase contrast-enhanced liver CT scan according to HCC protocol
  • MRI with contrast in patients who cannot tolerate appropriate CT contrast or where there is still uncertainty after the CT scan
  • contrast-enhanced ultrasound in select cases where CT or MRI are not suitable (e.g. poor renal function). In selected lesions, contrast-enhanced ultrasound may be useful.

If diagnostic uncertainty still remains, consider a liver biopsy.

Diagnostic investigations should be completed within four weeks of the initial referral.

Pharmacogenetics describes how individual genetic differences can lead to differences in the way certain medicines interact with the body. These interactions can affect the effectiveness of medications and any side effects. Applying pharmacogenetics to treatment planning may help patients to be prescribed the most appropriate treatment at the optimal dose from the beginning of treatment (NHMRC 2013).