Can Blood-Based Biomarkers Replace Ultrasound for HCC Surveillance?: Hepatology Communications | August 2026
Introduction:
Current HCC surveillance relies on ultrasound with AFP every 6 months, but ultrasound has limited sensitivity in patients with obesity or steatosis and real-world adherence remains suboptimal. This cost-effectiveness analysis evaluated whether blood-based algorithms HES V2.0 and GALAD could become viable alternatives for HCC surveillance in patients with cirrhosis.
Why was this study needed?
Ultrasound-based surveillance frequently misses early HCC.
Blood tests could offer standardized, accessible, and potentially better-adhered surveillance.
Higher biomarker sensitivity comes at the expense of false positives and additional imaging.
Practical performance and cost thresholds are needed before blood-based surveillance can be implemented.
Results:
At an assumed $200 per test, both HES V2.0 and GALAD could be cost-effective compared with ultrasound-based surveillance under defined performance thresholds.
HES V2.0 detected more very early-stage HCC than ultrasound, producing greater health benefit but also more downstream diagnostic imaging.
GALAD produced smaller gains but required fewer additional investigations.
Cost-effectiveness depended strongly on test price, sensitivity, specificity, and—importantly—patient adherence.
Clinical Impact:
This study provides a framework for moving HCC surveillance toward a blood-based strategy, particularly where ultrasound quality or adherence is poor. However, it is a modeling study rather than a clinical comparative trial; HES V2.0 and GALAD should therefore not yet replace guideline-recommended ultrasound-based surveillance.
Bottom Line:
Blood-based HCC surveillance with HES V2.0 or GALAD could become cost-effective in patients with cirrhosis if appropriate accuracy, pricing, and adherence are achieved. HES V2.0 may improve very early HCC detection, but prospective clinical validation is required before replacing ultrasound-based surveillance.
