Rosh Internal Medicine Boost Practice Exam

What is the best choice of surveillance for hepatocellular carcinoma in a patient with hepatitis B and hepatic cirrhosis?

1. Abdominal CT scan every 12 months

2. Abdominal CT scan every 2 years

3. Liver ultrasound every 12 months

4. Liver ultrasound every 6 months

The correct answer is: Liver ultrasound every 6 months

Liver ultrasound every 6 months is the recommended choice for the surveillance of hepatocellular carcinoma (HCC) in patients with hepatitis B and hepatic cirrhosis. This frequency is based on current guidelines that emphasize early detection of HCC in high-risk populations, which includes individuals with chronic hepatitis B infection and cirrhosis. Ultrasound is a practical and effective screening tool for HCC because it is non-invasive, widely available, and can be performed quickly. It allows for real-time visualization of the liver to detect masses that may represent tumors. The six-month interval is critical due to the aggressive nature of HCC and its tendency to grow and surpass the threshold of detection if surveillance is performed less frequently. Other choices such as CT scans, while they can provide more detailed images of liver tumors, are not recommended for routine surveillance due to higher costs, the need for more resources, and exposure to radiation. Additionally, annual scans may not be sufficient to catch changes in tumor size or newly formed lesions in a timely manner. Therefore, the best practice in this context is to perform liver ultrasounds every six months, which is particularly considerate of the patient population at risk for HCC.