Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

Table 2 Preoperative stadiation for patients with hepatocellular carcinoma evaluated for liver transplantation

Diagnostic test	Indications	Comments
Computed tomography (CT) with contrast medium of chest-abdomen-pelvis	Standard test to perform the diagnosis of hepatocellular carcinoma (HCC) in cirrhotic livers to characterize number, size and location of nodules, and exclude macrovascular invasion and extrahepatic spread	Require adherence to established protocols for optimization
Magnetic resonance imaging (MRI) with contrast medium of abdomen	Slightly superior to CT according to recent data	Consider in individual patients
Bone scan	Standard test to exclude bone spread	Cost-effectivity debated
Alpha-fetoprotein (AFP)	Center-specific cut-off for inclusion on the list and drop-out	Surrogate marker of biological aggressiveness
Preoperative biopsy	Proposed to assess tumor grading	Low accuracy
Positron emission tomography (PET)	Proposed predictor of HCC recurrence	Cost-effectivity unclear