American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended surveillance frequency for high-risk HBV patients for HCC?

1. Yearly

2. Every six months

3. Quarterly

4. Monthly

The correct answer is: Every six months

For high-risk patients with hepatitis B virus (HBV) infection, the recommended surveillance frequency for hepatocellular carcinoma (HCC) is every six months. This guideline is based on the increased risk that these patients have for developing liver cancer, especially as they may already have underlying liver disease such as cirrhosis or significant fibrosis. The rationale for the six-month interval lies in the natural history of HCC and the growth patterns of liver tumors. HCC can develop rapidly, and early detection significantly improves prognosis and treatment options. The surveillance typically includes imaging studies such as ultrasound, often combined with serum alpha-fetoprotein (AFP) testing, for better sensitivity in detecting tumors at an earlier, more treatable stage. Surveillance intervals longer than six months may not be adequate to catch early-stage tumors, while more frequent intervals such as quarterly or monthly are generally not necessary and could lead to patient burden without providing substantial additional benefit. Therefore, adhering to the biannual schedule strikes a balance between effective monitoring and practicality in clinical management.