Hepatology: diagnosis of hepatocellular carcinoma: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Hepatology: diagnosis of hepatocellular carcinoma

Sample item

A 55-year-old man with hepatitis C cirrhosis under six-monthly ultrasound surveillance has a new 2.5 cm liver nodule, and the serum alpha-fetoprotein is 600 ng/mL. What is the most appropriate next step?

AMultiphasic contrast CT or MRI looking for arterial enhancement with washoutBWhole-body PET-CT as the most sensitive testCRepeat the ultrasound in three monthsDImmediate percutaneous biopsy because imaging cannot diagnose this tumour

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Multiphasic contrast CT or MRI looking for arterial enhancement with washout

In a cirrhotic liver, a nodule larger than 1 cm that shows arterial phase hyperenhancement and portal venous or delayed washout on multiphasic CT or MRI is diagnostic of hepatocellular carcinoma without biopsy. Biopsy is reserved for indeterminate lesions. Treatment is chosen according to staging, for example BCLC.

Option by option

A. Multiphasic contrast CT or MRI looking for arterial enhancement with washout (correct)
Correct. Typical imaging features are diagnostic in a cirrhotic patient.
B. Whole-body PET-CT as the most sensitive test
FDG-PET is insensitive for well-differentiated hepatocellular carcinoma and is not used for diagnosis.
C. Repeat the ultrasound in three months
Delay risks progression of a lesion above 2 cm with a markedly raised AFP.
D. Immediate percutaneous biopsy because imaging cannot diagnose this tumour
Biopsy carries bleeding and tract seeding risk and is unnecessary when imaging is typical.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Multiphasic contrast CT or MRI looking for arterial enhancement with washout. In a cirrhotic liver, a nodule larger than 1 cm that shows arterial phase hyperenhancement and portal venous or delayed washout on multiphasic CT or MRI is diagnostic of hepatocellular carcinoma without biopsy.

Why is "Whole-body PET-CT as the most sensitive test" not the answer?

FDG-PET is insensitive for well-differentiated hepatocellular carcinoma and is not used for diagnosis.

Why is "Repeat the ultrasound in three months" not the answer?

Delay risks progression of a lesion above 2 cm with a markedly raised AFP.

Why is "Immediate percutaneous biopsy because imaging cannot diagnose this tu…" not the answer?

Biopsy carries bleeding and tract seeding risk and is unnecessary when imaging is typical.

What concept does this question test?

It tests Hepatology: diagnosis of hepatocellular carcinoma in General Medicine. Biopsy is reserved for indeterminate lesions. Treatment is chosen according to staging, for example BCLC.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatology: diagnosis of hepatocellular carcinoma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.