In Germany, more than 80% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis of the liver (1). Early detection is crucial for the overall prognosis in this setting (2). The German Clinical Practice (S3) Guideline—published in 2013 by the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS)—included the recommendation for sonography screening of at-risk patients every six months, so as to improve the early detection rate (3). The current study compares the early detection rate and its effect on the overall prognosis before and after publication of the guideline.