Diagnosis of Small Hepatocellular Carcinoma: Significance of Ultrasound and Tumor Markers

Ultrasound (US) and tumor markers were used to examine 23 patients with small hepatocellular carcinoma (HCC) measuring less than 2 cm in diameter. US detected tumor echoes in 22 patients (96%). US patterns of internal echoes obtained from 22 patients with small HCC, included hypoechoic patterns in 13 (59%), an isoechoic pattern in one (5%), hyperechoic patterns in seven (32%) and a mixed pattern in one (5%). These US findings were very different from those characteristic of large HCC that had been reported previously; few mosaic patterns, marginal hypoechoic zones (halo), lateral shadows or posterior echo enhancement were found. Alpha-fetoprotein (AFP) was positive, more than 21 ng/ml, in 65 percent of the patients, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) was positive, more than 0.1 AU/ml, in 38 percent of the patients.