ACR Appropriateness Criteria® Staging and Follow-Up of Primary Liver Cancer

Liver cancer is the sixth most common cancer worldwide, with 905,677 new cases in 2020, and the third leading cause of cancer-related deaths globally. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and accounts for approximately 75% to 85% of cases. Ultimately, the management of HCC encompasses multiple disciplines including hepatologists, diagnostic radiologists, pathologists, transplant surgeons, surgical oncologists, radiation oncologists, and more. The development of a multidisciplinary clinic with dedicated tumor board review has been shown to increase survival in these patients with HCC. This document aims to guide the imaging of HCC, including screening, staging, active surveillance during liver-directed therapy, and in the setting of previously treated HCC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.