Diagnosis, clinical assessment, and staging of hepatocellular carcinoma: a Brazilian multidisciplinary consensus

Abstract

ABSTRACT 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.