Review of hepatic imaging and a problem-oriented approach to liver masses

Bennett, William F.; Bova, James G.

doi:10.1002/hep.1840120423

Cited by 53 publications

(12 citation statements)

References 56 publications

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“…From the Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, 1 Department of Radiology, 2 Faculty of Medicine, University of Tokyo, Tokyo, Japan.…”

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confidence: 42%

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

et al. 1999

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Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are probably underestimated. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, for defining indications for surgery in a cohort of patients with focal liver lesions (FLLs). Between January 1997 and December 1998, 160 consecutive patients carrying 225 FLLs admitted to our department were evaluated prospectively. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography, and spiral computed tomography (CT). Angiography, magnetic resonance imaging (MRI), and Lipiodol-CT were performed when it was considered necessary to plan the surgical strategy. All the patients underwent surgery and results of pathological examinations were obtained for all of them. The preoperative diagnoses of 221 of the 225 lesions (98.2%) were confirmed, and the indications for liver resection in 156 of the 160 patients (97.5%) were correct. The respective accuracy, sensitivity, specificity, and positive and negative predictive values were 99.6%, 100%, 98.9%, 99.3%, and 100% for diagnosis of hepatocellular carcinoma (HCC); 99.1%, 100%, 98.8%, 96.9%, and 100% for metastases; 99.6%, 100%, 99.5%, 91%, and 100% for cholangiocellular carcinomas (CCCs); all 100% for mixed HCC-CCCs; and 98.7%, 57.1%, 100%, 100%, and 98.6% for benign tumors. In view of these results, the fact that the real risks of FNB have yet to be established and the possibility that tumor seeding has a major impact on patient prognosis, the use of FNB should be drastically limited. (HEPATOLOGY 1999;30:889-893.)Differential diagnosis of focal liver lesions (FLLs) is not always easy, despite the progress made with the latest imaging techniques. 1,2 It is generally accepted that in most cases, fineneedle biopsy (FNB) is safe, accurate, and enables a definitive diagnosis to be made quickly. [3][4][5][6][7][8][9][10] However, some problems, such as the well known possibility of neoplastic seeding 11,12 and the conflicting results of diagnosis in patients with well-differentiated hepatocellular carcinomas (HCCs) 13-15 and benign tumors, 1,16 represent limitations that should be considered further. In particular, precise details of the prevalence of tumor cell seeding along the needle tract have yet to be determined, despite the fact that this problem is real 17 and its occurrence leads to a worse prognosis.Our diagnostic work-up for FLLs has never included FNB, and the aim of this study was to validate prospectively its accuracy for diagnosing FLLs, and consequently establishing the correct indications for surgery, in a cohort of patients admitted to our department. MATERIALS AND METHODSPatients were entered into the study if they satisfied the following selection criteria: (1) they were carrying hepatic solid nodules that had not been treated previously and (2) they had not undergone previous FNB of the liver. We considered the possibility of a selection bias owing to the fact that only patien...

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Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

et al. 1999

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“…FNH nodules generally show no malignant transformation tendency [50]. The complications they cause include intralesional hemorrhage, which occurs in 2e3% of all cases [5].…”

Section: Clinical Aspectssupporting

confidence: 42%

Diagnosis and management of hepatic focal nodular hyperplasia

Venturi

Piscaglia

Vidili

et al. 2007

Journal of Ultrasound

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Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.Sommario L'iperplasia nodosa focale (FNH) è il tumore epatico benigno più frequente dopo l'angioma. E' di solito rilevata in modo occasionale, per lo più nelle donne in età fertile, anche se si può riscontrare in entrambi i sessi e ad ogni età. I soggetti portatori raramente sono sintomatici, nonostante l'FNH possa essere causa di dolore ai quadranti addominali superiori. Nella gestione dell'FNH il problema clinico principale è rappresentato dalla difficoltà di differenziarla dalle altre lesioni epatiche ipervascolarizzate, come l'adenoma, l'epatocarcinoma o le metastasi ipervascolari, tuttavia utilizzando le opportune tecniche diagnostiche è oggi possibile evitare il ricorso ad esami invasivi. La Risonanza Magnetica (RM) ha una sensibilità e una specificità superiori rispetto a quelle dell'ecografia convenzionale e della Tomografia Assiale Computerizzata (TC) per la diagnosi di FNH. L'uso dell'angioecografia perfusionale (CEUS) e dell'eco-Doppler può tuttavia aumentare in modo significativo la confidenza diagnostica

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“…However, diVerential diagnosis of these lesions is not easy, despite the progression of imaging techniques. (Bennett and Bova 1990;Menu 2004) Furthermore, the usefulness of invasive biopsy is limited by false-negatives (Durand et al 2001) and signiWcant risks for tumor seeding. (Durand et al 2001;Talwalkar and Gores 2004;Takamori et al 2000).…”

Section: Discussionmentioning

confidence: 43%