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We read with great interest the leading article by Tremosini et al in Gut (2012 doi:10.1136/gutjnl-2011-301951) which prospectively assessed the diagnostic accuracy of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in patients with cirrhosis with a small (5–20 mm) nodule detected by ultrasound screening.1 Finally, they established the clinical usefulness of that panel of markers for the diagnosis of early hepatocellular carcinoma (HCC). Then, something that logically or naturally follows from the early detection would be the treatment for early small HCC, that is, what the real role of each early modality plays in clinical practice.
Surveillance programmes for early detection of small nodular-type HCC have increased the number of patients suitable for surgical treatment. However, unlike other solid tumours, surgical resection plays a limited role in patients with HCC because of the lack of hepatic reserve as a result of coexisting cirrhosis or the presence of multiple tumours. Besides, liver …
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