Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer worldwide and as such represents a significant global health burden. The clinical societies dedicated to the study of liver diseases all recommend routine surveillance for those at risk. These societies include the Asian-Pacific, European, and American associations for the study of liver disease. The aim of surveillance is to prolong survival, which is to diagnose HCC when the patient remains eligible for potentially curative interventions including resection and transplantation. In a detailed review published recently, Kanwal and Singal discuss the evidence for HCC surveillance, evaluate current surveillance methods and point out new imaging and serological initiatives to improve on current method (1). Their review covers some familiar topics and point to new endeavors in improving the effectiveness of HCC surveillance. In regards to their review article, several important points need to be emphasized as follows.