Microvascular Invasion in Hepatocellular Carcinoma (Hcc): Implications and Strategy

Purpose of Review: To review the published literature on microvascular invasion (MVI) in hepatocellular carcinoma (HCC) and to evaluate its prognostic impact, strategies for prediction, and implications for clinical management. A comprehensive search was performed using the Medline, Embase, Cochrane, and Web of Science databases, without restriction on publication year; English-language articles were prioritized. Both clinical series and review articles were included. Recent Findings: MVI, defined as the presence of tumor cells within portal veins, capsular vessels, or other endothelial-lined vascular spaces, is strongly associated with aggressive tumor biology. Its presence correlates with higher recurrence rates and reduced overall survival after curative treatments such as resection, ablation, or transplantation. Although several clinicopathological factors and imaging features have been linked to MVI, accurate preoperative prediction remains challenging. Recent advances in radiomics and imaging-based models show promise as noninvasive tools for risk stratification, while surgical margin width and resection strategy appear to influence outcomes particularly in small tumors with MVI. Summary: MVI is a key determinant of prognosis in HCC, yet it can currently be diagnosed only on histological examination. Improved methods for preoperative prediction could guide more individualized treatment strategies, optimizing surgical and ablative approaches and ultimately improving long-term outcomes.