The BALAD (bilirubin, albumin, Lens culinaris agglutinin-reactive AFP (AFP-L3), AFP and DCP/PIVKA-II) and subsequent GALAD (gender, age, AFP-L3, AFP and DCP/PIVKA-II) scoring systems were developed in an attempt to overcome the insufficient performance of ultrasound imaging for HCC detection, by combining three well characterised and commercially available serum biomarkers (AFP-L3, AFP and DCP/PIVKA-II) [10–12]. Here, ACE is linked to hepatocellular carcinoma.