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A 45-year-old bus driver without known liver disease was admitted to the emergency ward in the context of abdominal pain. During diagnostic work-up, blood examination showed a bilirubin of 0.8 mg/dL (14 µmol/L), ALT 45 U/L, AST 40 U/L, ALP 210 U/L, and ℽGT 217 U/L, normal INR, AFP 200 mg/dL. HBsAg and anti-HCV were negative. A CT scan disclosed a nodule of 5 cm with segmental vascular invasion in the liver, fulfilling the radiological criteria of LIRADS 5. No signs of portal hypertension or decompensation were found.

HCC can be diagnosed either based on histopathology or non-invasive criteria. Which recommendation follows the actual EASL clinical practice guidelines?

A. Histopathology-based diagnosis is mandatory for all non-cirrhotic cases

B. In non-cirrhotic individuals, imaging showing a LIRADS 5 lesion will suffice for patients with HBV infection

C. Non-invasive (imaging) criteria should be based on MRI, CT scan or FDG PET-scan

D. The levels of recommendation for HCC diagnosis are equal for MRI, CT scan or contrast-enhanced ultrasound (CEUS)

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