## Diagnostic Confirmation of HCC in Cirrhotic Liver **Clinical Context:** - Patient has cirrhosis (risk factor) + imaging finding + elevated AFP - Single imaging modality + elevated AFP is insufficient for definitive diagnosis in nodules 1–2 cm - For nodules >1 cm, imaging criteria alone may not be diagnostic **Why Liver Biopsy is Correct:** - **Gold standard** for histological confirmation of HCC - Provides definitive diagnosis when imaging is equivocal or non-diagnostic - Allows grading and assessment of surrounding liver parenchyma - Essential when diagnosis is uncertain despite imaging and tumor markers **Key Point:** In a cirrhotic with a 3 cm lesion and AFP 450 ng/mL, while imaging + AFP may suggest HCC, **biopsy remains the gold standard for tissue diagnosis** when confirmation is needed for treatment planning. **High-Yield:** AASLD guidelines recommend biopsy when imaging findings are not typical or when diagnosis is in doubt, even with elevated AFP.
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