Alpha-fetoprotein (AFP) is the most widely used biomarker for HCC worldwide but, due to its suboptimal sensitivity and specificity in surveillance (fluctuating low levels that may be due to flare of viral hepatitis and small proportion of early stage tumours secreting AFP), the previous American Association for the Study of Liver Diseases (AASLD) and the current European Association for the Study of the Liver (EASL) guidelines for surveillance recommend six-monthly ultrasound imaging (US) alone [5, 6]. This evidence concerns the gene AFP and animal viral hepatitis.