Refining early detection of hepatocellular carcinoma: The promise of the GALAD score

This letter discusses the original article by Villa <i>et al</i>, published in the <i>World Journal of Gastroenterology</i>. Our primary focus is on the GALAD score, its components, standardization, and population-specific variations. We also attempted to discuss the current applications of GALAD score and how combining it with imaging modalities like ultrasound could improve it. Hepatocellular carcinoma (HCC) is still one of the leading causes of cancer death, and early detection is crucial to its prognosis. Current surveillance methods, like alpha-fetoprotein (AFP) and ultrasound, are not very specific, especially when it comes to metabolic-associated steatotic liver disease. Gender, age, AFP, AFP-L3, and des-gamma-carboxy prothrombin are all included in the operator-independent, non-invasive GALAD score, which has become a promising biomarker-based diagnostic tool for HCC. Population-specific cut-points with high sensitivity and specificity have been proposed by multicenter studies like Villa <i>et al</i>, particularly for differentiating between HCC and cirrhosis and healthy controls. However, there is no universal threshold due to variation across etiology, population, and assay technology. GALAD must be a context-sensitive auxiliary in the clinical setting, guiding surveillance intervals and imaging choices while improving predictive performance through serial measurement. Early detection is further improved by integration with imaging modalities, such as the GALADUS score. Standardized biomarker techniques and prospective, multi-ethnic validation are required for broad clinical use and optimal HCC surveillance.