GALAD Model for Hepatocellular Carcinoma Diagnosis
Validated HCC diagnostic model combining Gender, Age, AFP-L3 (lens culinaris agglutinin-reactive fraction of AFP), AFP, and DCP (des-gamma-carboxyprothrombin; PIVKA-II). Developed by Johnson et al. 2014. Superior to AFP alone for early HCC detection. Validated across multiple aetiologies (HBV, HCV, ALD, NAFLD). GALAD score above -1.68 = HCC likely.
Score interpretation
GALAD at or below -1.68 -- lower probability of HCC
→ Continue routine HCC surveillance: liver ultrasound every 6 months (plus AFP if available per local protocol); if GALAD used as surveillance tool, any rise towards threshold warrants repeat testing in 1-3 months; ensure underlying liver disease managed optimally (HBV/HCV treatment, ALD abstinence, NAFLD weight management); refer to hepatologist if not already under follow-up; do not rely on GALAD alone if USS is suspicious -- proceed to CT/MRI LI-RADS assessment regardless.
GALAD above -1.68 -- elevated probability of HCC; urgent imaging required
→ Urgent triple-phase CT or contrast-enhanced MRI (LI-RADS classification) within 2 weeks; if LI-RADS 4 or 5: hepatobiliary MDT referral; biopsy if LI-RADS 3 and no clear diagnosis; consider CT chest/abdomen/pelvis for staging; if confirmed HCC: BCLC staging for treatment allocation (surgical resection, ablation, TACE, SIRT, sorafenib/lenvatinib/immunotherapy); notify patient clearly; discuss potential diagnosis sensitively with specialist nurse support; follow NHSC (National HCC Framework) pathway; ensure liver transplant assessment if within Milan/UCSF criteria.
Interpretation bands for the GALAD Score. Apply clinical judgement and local guidance.
References
- Johnson PJ et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach -- the ALBI grade. J Clin Oncol. 2015;33(6):550-558.
- Best J et al. Performance of the GALAD model in the surveillance of patients with established liver cirrhosis for the occurrence of hepatocellular carcinoma. PLoS One. 2020;15(2):e0229251.
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.