Biopsy for hepatocellular carcinoma: only occasionally.

We would like to highlight that the non-invasive criteria for HCC diagnosis, defined by the presence of hyperenhancement in the arterial phase (wash-in) followed by hypoenhancement (wash-out) in venous phases on MRI and/or CT, have been validated by multiple cohort studies and meta-analysis. These criteria are only applicable when the pre-test probability is high (lesions > 1 cm in patients diagnosed of liver cirrhosis or chronic hepatitis B). In addition, for an adequate use of these criteria, other processes such as active (or past) neoplasms must be ruled out. In this scenario, non-invasive criteria have repeatedly demonstrated a diagnostic specificity and positive predictive value close to 100 %. Moreover, we would like to remark the transversality in the consensus of the non-invasive diagnosis of HCC, since not only the hepatology societies recommend its use, but also the oncology and radiology ones.