The Evolving Application of Ultrasound in the Precision Management of Small Hepatocellular Carcinoma

Early detection of hepatocellular carcinoma (HCC) is crucial, as patient outcomes depend largely on clinical stage and treatment options at diagnosis. Currently most clinical guidelines emphasize non-invasive cross-sectional imaging for HCC diagnosis and evaluation, yet the full potential of ultrasound is often underexplored. With the development of emerging ultrasound techniques and diagnostic algorithms in recent years, the diagnostic ability of ultrasound for HCC smaller than 3 cm has been substantially improved and is increasingly emphasized in the management of small HCC. Following sequential clinical scenarios, this review discusses the state-of-the-art of ultrasound-related techniques and algorithms for preoperative screening and diagnosis, intraoperative guidance and monitoring as well as posttreatment efficacy evaluation of small HCC. By highlighting how advanced ultrasound complements and enhances standard practices, this review aims to promote ultrasound as an indispensable, versatile, and dynamic tool in the precision management of small HCC.