We analyzed the clinical-diagnostic features of 67 cases of hepatocellular carcinoma (HCC) collected from June 1981 to December 1985. The male-to-female ratio was 3.4:1, the average age was 66.7 years; alcohol abuse was present in 38 cases (56.7%); HbsAg positivity was present in 10 of 62 patients (16.1%); the alpha-fetoprotein (AFP) level was greater than 500 ng in 17 of 61 patients (28%) and normal in 24 of 61 (39.3%). Concomitant cirrhosis was found in 51 patients (76.1%). The median survival of the whole group was of 10 weeks from diagnosis. The clinical suspicion of HCC was arisen by ultrasound (US) and the diagnostic was confirmed cytologically in 57 patients out of 60 who underwent ultrasonically guided fine-needle biopsy (UG-FNB), with a sensitivity of 95% and specificity of 100%. In 7 cases (including the 3 false-negative FNB), the diagnosis was made by laparoscopic biopsy and, in 3 cases, on autopsy. US identified a single tumor in 27 cases (40.3%); 7 were smaller than 5 cm. Only 4 patients (5.9%) were considered for surgery. We conclude that the cirrhotic patients (above all those HbsAg positive) constitute a high-risk group requiring periodic (every 3 months) US examination. To confirm the HCC, we believe in the high diagnostic accuracy of UG-FNB, whereas laparoscopy should be confirmed to the cases where FNB gives a doubtful false-negative result or to complete the presurgical staging.