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
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.
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.