Hepatobiliary and pancreatic surgery: non-invasive diagnosis of HCC: practice question

A General Surgery 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.

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General Surgery · Hepatobiliary and pancreatic surgery: non-invasive diagnosis of HCC

Sample item

A 55-year-old man with hepatitis B cirrhosis has a 3 cm nodule found on surveillance ultrasound. Multiphase CT shows arterial-phase hyperenhancement with washout in the portal venous phase. What is the appropriate next step?

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

The answer and the reasoning

B. Treat as hepatocellular carcinoma without biopsy

In a cirrhotic liver, a nodule larger than 1 cm with arterial hyperenhancement and washout is diagnostic of hepatocellular carcinoma on imaging alone. Biopsy is not required and carries a small risk of needle-tract seeding.

Option by option

  • A. Percutaneous biopsy before any treatment

    Biopsy is reserved for atypical imaging and adds the risk of tract seeding.

  • B. Treat as hepatocellular carcinoma without biopsy (correct)

    Correct. Typical imaging features in cirrhosis are sufficient for diagnosis and treatment planning.

  • C. Repeat ultrasound in three months

    Delay allows a proven cancer to progress.

  • D. Measure CEA and CA 19-9 and wait

    CEA and CA 19-9 are not the markers for this tumour, which is monitored with alpha-fetoprotein.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Treat as hepatocellular carcinoma without biopsy. In a cirrhotic liver, a nodule larger than 1 cm with arterial hyperenhancement and washout is diagnostic of hepatocellular carcinoma on imaging alone.

Why is "Percutaneous biopsy before any treatment" not the answer?

Biopsy is reserved for atypical imaging and adds the risk of tract seeding.

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

Delay allows a proven cancer to progress.

Why is "Measure CEA and CA 19-9 and wait" not the answer?

CEA and CA 19-9 are not the markers for this tumour, which is monitored with alpha-fetoprotein.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: non-invasive diagnosis of HCC in General Surgery. Biopsy is not required and carries a small risk of needle-tract seeding.

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 Hepatobiliary and pancreatic surgery: non-invasive diagnosis of HCC?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.