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Introduction Hepatocellular carcinoma (HCC) incidence in the UK has increased by 50% over the past decade and continues to rise. 1 Imaging (USS) Surveillance is nationally and internationally recommended for high-risk groups, including those with cirrhosis, advanced fibrosis and hepatitis B.2 Surveillance aims to facilitate early detection, curative treatment, and improved survival; however, there are concerns that fewer than half of eligible patients are enrolled, and uncertainty of numbers currently identified through existing surveillance practices in clinic.3 Recent NHSE initiatives have led to the development of standardised HCC surveillance strategies in Trusts, with dedicated surveillance databases now being created, in addition to recall strategies for imaging. But, the number of patients currently identified through surveillance programmes is unknown, and therefore the baseline we aim to improve, and stage of detection for HCC.The current audit assess trends in patient referrals and discussions in a single regional HCC MDT, and the number of HCC patients currently identified through surveillance.Methods Patients discussed at SSCA regional HCC MDT meetings between March 2024 and March 2025 were included. Electronic records and imaging systems were reviewed to determine the method of initial liver lesion detection. Demographic data and relevant medical history were collected, compiled, and analysed independently by the author. Duplicates were removed, and 14 patients excluded due to incomplete records.Results Of 214 patients included (74% male; median age 69), 62 (29%) were under HCC surveillance at diagnosis. Notably, 10 of these were diagnosed between scheduled scans due to rising Alpha-fetoprotein, new symptoms, or incidental findings.Among non-surveillance patients, lesions were detected incidentally through alternative surveillance programmes or unrelated imaging (18%), following deranged liver function tests (15%), during index presentation with decompensated cirrhosis (14%), or due to non-specific symptoms (23%), commonly abdominal pain, weight loss, or altered bowel habits. Three patients were classified as ‘other’: two with haemorrhagic HCC requiring emergency resection, and one identified via private surveillance. Of the 152 non-surveillance patients, 58.6% had underlying cirrhosis.Abstract P62 Figure 1Discussion/Conclusion Only 29% of patients discussed at HCC MDT were enrolled in HCC surveillance, and several had undiagnosed cirrhosis at presentation, suggesting missed surveillance opportunities.The non-specific nature of HCC symptoms at presentation highlights the need for routine surveillance. Some patients developed HCC between scheduled 6-monthly scans, suggesting that higher-risk individuals might benefit from more frequent, tailored surveillance.Overall, the findings reveal gaps in surveillance enrolment and reinforces current initiatives for new regional and national surveillance pathways.References Williams J, Foster L. Surrey and sussex cancer alliance service guidance for hepatocellular carcinoma surveillance. 2025 Feb.Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: a meta-analysis. J Hepatol. 2022 Jul;77(1):128–39.The European Association for the Study of the Liver. EASL Policy Statement: Risk-based surveillance for hepatocellular carcinoma among patients with cirrhosis [Internet]. Geneva; 2023 Apr. Available from: www.easl.eu