Exploring Opportunities to Enhance the Screening and Surveillance of Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease (NAFLD) through Risk Stratification Algorithms Incorporating Ultrasound Elastography

SIMPLE SUMMARY: Non-alcoholic fatty liver disease (NAFLD) has become a significant public health concern, affecting over 30% of the population. The incidence of NAFLD-related hepatocellular carcinoma (HCC) has been rising, with unique pathogenic factors compared to other causes of HCC. Early detection is crucial for better outcomes. Currently, it is still unclear which subset of non-cirrhotic NAFLD-patients could benefit from HCC screening, and a better characterization and stratification of this population is required. This review underscores the potential of liver ultrasound elastography as a risk assessment tool for HCC development in NAFLD. Alongside exploring the potential advancement of non-invasive tools and algorithms for effectively stratifying HCC risk in NAFLD, we offer essential insights that could enable readers to enhance the personalized assessment of NAFLD-related HCC risk in a more systematic manner. ABSTRACT: Non-alcoholic fatty liver disease (NAFLD), with its progressive form, non-alcoholic steatohepatitis (NASH), has emerged as a significant public health concern, affecting over 30% of the global population. Hepatocellular carcinoma (HCC), a complication associated with both cirrhotic and non-cirrhotic NAFLD, has shown a significant increase in incidence. A substantial proportion of NAFLD-related HCC occurs in non-cirrhotic livers, highlighting the need for improved risk stratification and surveillance strategies. This comprehensive review explores the potential role of liver ultrasound elastography as a risk assessment tool for HCC development in NAFLD and highlights the importance of effective screening tools for early, cost-effective detection and improved management of NAFLD-related HCC. The integration of non-invasive tools and algorithms into risk stratification strategies could have the capacity to enhance NAFLD-related HCC screening and surveillance effectiveness. Alongside exploring the potential advancement of non-invasive tools and algorithms for effectively stratifying HCC risk in NAFLD, we offer essential perspectives that could enable readers to improve the personalized assessment of NAFLD-related HCC risk through a more methodical screening approach.