Objective:

To identify, appraise and synthesize studies reporting the accuracy of tests for detecting hepatocellular carcinoma (HCC) in patients with cirrhosis.

Approach:

• Design: Systematic review and network meta-analysis of diagnostic test accuracy (NMA-DTA) data.
• Data Sources: MEDLINE and Embase (2005 to September 2025) and a published Cochrane review.
• Eligibility Criteria: English-language, post-2005 studies quantifying diagnostic accuracy of tests to detect HCC in cirrhotic populations, excluding those with pre-existing signs and symptoms of HCC.
• Data Extraction and Synthesis: Data extracted by one reviewer, checked by a second, assessed for bias using QUADAS-2, and synthesized using Bayesian NMA-DTA.

Key Findings:

• Included 170 studies with 62,643 participants; 97 index tests were amenable to NMA-DTA.
• Ultrasound sensitivity for very-early-stage HCC was 0.34 (95% CrI 0.21 to 0.55), while alpha-fetoprotein was 0.39 (95% CrI 0.28 to 0.47).
• Contrast-enhanced MRI showed higher sensitivity (0.70 (95% CrI 0.50 to 0.84) for very-early; 0.86 (95% CrI 0.73 to 0.94) for early; 0.90 (95% CrI 0.67 to 0.98) for advanced stages).
• CT sensitivity was 0.68 (95% CrI 0.26 to 0.93) for very-early; 0.77 (95% CrI 0.29 to 0.95) for early; 0.92 (95% CrI 0.49 to 0.99) for advanced stages.
• No genomic biomarkers demonstrated significant improvements over conventional blood markers.

Interpretation:

Tests have low sensitivity for detecting early-stage HCC, indicating a need for better diagnostic methods.

Limitations:

• Most studies included were at high risk of bias.
• Findings may not be generalizable beyond the studied populations.

Conclusion:

The study highlights the inadequacy of current surveillance tests for early-stage HCC detection and emphasizes the need for improved testing strategies.

Sources:

• Systematic Review and Network Meta-Analysis