SSAT/AHPBA joint symposium on evaluation and treatment of benign liver lesions

Is This Patient's Liver Mass Cancer?

Undiagnosed liver lesions are important findings that can affect the physical and mental well-being of patients. They are usually incidental findings identified while clinicians are performing other imaging tests. It is important for clinicians and patients to identify the causative factors for these lesions in order to further reduce risk, develop treatment plans, and produce better outcomes. Both men and women can develop liver lesions, which may require surgical intervention. Knowing the key risk factors for common lesions can help clinicians confidently diagnose patients without costly workup.

Imaging Surveillance of Hypervascular Liver Lesions in Non-Cirrhotic Patients

A consensus surveillance protocol is lacking for non-cirrhotic patients with hypervascular liver lesions presumed to represent hepatocellular adenomas. Patients with hypervascular liver lesions <5 cm not meeting criteria for focal nodular hyperplasia or hepatocellular carcinoma underwent surveillance with contrast-enhanced magnetic resonance imaging (MRI) 6, 12, and 24 months after baseline imaging. If lesions remained stable or decreased in size, then surveillance imaging was discontinued. Between 2011 and 2014, 116 patients with hypervascular liver lesions were evaluated. Seventy-nine patients were eligible for the surveillance protocol. Median follow-up was 24 months (range, 1-144 months). One patient (1 %) continued oral contraceptive pill (OCP) use and presented with hemorrhage requiring embolization 5 months after initial diagnosis. Ten patients (13 %) underwent elective embolization or surgical resection for size ≥5 cm. The remaining 68 patients (86 %) continued surveillance without hemorrhage or malignant transformation. Risk factors for requiring intervention during the surveillance period included younger age, larger lesion size, and estrogen use (all p < 0.05). Patients with hepatocellular adenomas <5 cm can safely be observed after discontinuing OCP with serial imaging 6, 12, and 24 months after diagnosis. If lesions remain stable or decrease in size, then longer-term surveillance is unlikely to identify patients at risk for complications.