Objectives: to determine the diagnostic accuracy of alpha-fetoprotein (AFP), ultrasound (US), their combination, contrast ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis and assessment of hepatocellular carcinoma (HCC) resectability in people with chronic liver disease using Cochrane systematic reviews and metaanalyzes. An additional objective is to create an evidence-based diagnostic algorithm for assessment of people with suspected hepatocellular carcinoma. Patients and methods: we included patients from primary diagnostic accuracy studies which were obtained through a systematic search of relevant scientific databases. From each included primary study, data on true positive, false positive, false negative and true negative results for each diagnostic procedure was obtained. Using appropriate meta-analytical models, the values of pooled sensitivity, pooled specificity and post-test probabilities for positive and negative tests were calculated. Results are presented with forest plots, ROC graphs (receiver operating characteristics) and post-test probability curves. Comparisons of diagnostic procedures was also performed in two levels of diagnostic work-up: triage tests and additional tests. Results: systematic literature search yielded a total of 141,651 records. After excluding duplicates and records based on titles and abstracts, 929 full-texts were analyzed, and in total 451 primary studies were included in the final analyzes. Among the triage tests, the combination of AFP with a cut-off value of 20 ng/mL and US has the highest diagnostic accuracy and post-test probability for a negative test result of 1 % (95 % CI 0.4 % to 2.5 %). Among additional tests, the highest post-test probabilities for a positive test result are found in CEUS 96.6 % (95 % CI 94.1 % to 98 %) and MR 94.5 % (95 % CI 91.5 % to 96,5 %), respectively. For the purpose of assessing HCC resectability, MR has the best diagnostic accuracy with a sensitivity of 84.3 % (95 % CI 77.6 % to 89.3 %) and a specificity of 92.9 % (95 % CI 88.3 % to 95,9 %), respectively. A diagnostic algorithm was designed based on all results. Conclusions: all triage tests have high accuracy in excluding HCC, and the optimal diagnostic procedure is a combination of AFP with a cut-off value of 20 ng/mL and US. CEUS and MR are optimal diagnostic procedures for confirming HCC, while MR is optimal for assessing HCC resectability. Among additional tests, CT has the lowest accuracy in disease confirmation and is therefore recommended as the modality of choice for disease staging.