A 60-year-old man with hereditary haemochromatosis (C282Y homozygous) and cirrhosis has AFP rising from 12 to 340 ng/mL over 3 months. Triphasic CT shows a 3.2 cm arterially enhancing liver lesion with washout. What is the most appropriate next step?

• A Liver biopsy of the lesion for histological confirmation before any treatment
• B Repeat CT in 3 months to confirm growth
• C Treat as metastatic lesion; colonoscopy and endoscopy to find primary
• D Diagnose HCC radiologically (LI-RADS 5) and proceed to curative therapy without biopsy ✓

Explanation

AASLD and EASL guidelines allow diagnosis of HCC in cirrhotic patients based on imaging alone (without biopsy) when a lesion ≥1 cm demonstrates typical vascular features on contrast-enhanced CT or MRI — arterial enhancement (wash-in) and venous/delayed washout. This constitutes LI-RADS 5 (HCC) classification. Biopsy is not required in this classical imaging scenario and risks needle tract seeding. Curative options (resection, transplant, ablation) should be offered without delay.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.