American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the main method for hepatocellular carcinoma (HCC) surveillance in patients with chronic hepatitis B infection?

1. Endoscopic retrograde cholangiopancreatography

2. Cross-sectional imaging with ultrasound, CT, or MRI

3. Serum alpha-fetoprotein level

4. Liver biopsy

The correct answer is: Cross-sectional imaging with ultrasound, CT, or MRI

Cross-sectional imaging, specifically using ultrasound, CT (computed tomography), or MRI (magnetic resonance imaging), is the primary method for surveillance of hepatocellular carcinoma (HCC) in individuals with chronic hepatitis B infection. This method is favored because it provides a non-invasive means of identifying liver lesions, enabling early detection of tumors that might be amenable to curative treatment. Surveillance is critical in patients with chronic hepatitis B due to their increased risk of developing HCC. Ultrasound is particularly valuable as it is widely available, cost-effective, and can be performed at regular intervals without significant risk to the patient. Moreover, when lesions are detected, further cross-sectional imaging such as CT or MRI can help characterize them and assess for any vascular invasion or metastasis, which are important for staging and treatment planning. While serum alpha-fetoprotein levels can provide supplementary data, they are not used alone for surveillance since not all HCC cases will result in elevated levels of this marker, and not all elevations indicate cancer. Endoscopic retrograde cholangiopancreatography is typically not employed for HCC surveillance and is more suited for evaluating biliary conditions. Liver biopsy is also not a first-line approach for surveillance due to its invasive nature and the