Surveillance with abdominal ultrasound (US) of patients with chronic liver disease who are at risk of developing a hepatocellular carcinoma (HCC), has progressively emerged as a consolidated practice for achieving early diagnosis and improving treatment of liver cancer, despite the lack of robust evidence-based data. Surveillance is recommended by the inteational societies from both hemispheres (1-3), where however recommendations from Far East voice some nuances with respect to the need for adding serum alfa fetoprotein (AFP) to US and of adopting accelerated intervals of screening for patients at very high risk of HCC, like those with viral hepatitis and multiple co-morbidities. A recent meta-analysis form the US confirms indeed a benefit in adding serum AFP to US (4). In the weste world, a 6-month interval is considered more than adequate for screening patients with compensated cirrhosis of any aetiology, as several meta-analyses have reported appreciable survival benefits in those patients who had a small tumor detected with US surveillance that ultimately could access curative treatment with liver transplantation, hepatic resection or local ablation (5,6).