This retrospective study was undertaken to assess the place and efficacy of ultrasonography, and ultrasound-guided biopsy in the diagnosis of hepatocellular carcinoma in a series of 34 patients. The sonographic signs were not specific, as tumor patterns were very different from one case to another; there were no pathognomonic signs of hepatocellular carcinoma in comparison with hepatic metastases. Tissue characterization of the liver abnormalities was obtained by percutaneous ultrasound-guided biopsies. In our experience, ultrasonography has a double role: demonstration of hepatic nodules, particularly in high risk patients (cirrhosis); histologic identification of the nodules by ultrasound-guided biopsy.