We read with great interest the article by Tzartzeva et al1 recently published in Gastroenterology that explored, using a systematic review and meta-analysis, surveillance imaging and alpha-fetoprotein (AFP) for the early detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. In this study, the authors reported that ultrasound examination alone to detect early-stage HCC has a low sensitivity in patients with cirrhosis. However, addition of AFP to ultrasound analysis significantly increases the sensitivity of HCC detection in clinical practice.