medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2015, Number 3

<< Back Next >>

Ann Hepatol 2015; 14 (3)

Diagnosis of liver nodules within and outside screening programs

Colombo M

Language: English
References: 16
Page: 304-309
PDF size: 85.21 Kb.


ABSTRACT

Evaluation of a liver nodule detected with ultrasound includes the recovery of a detailed medical history, a physical exam, appropriate contrast imaging examinations and, in selected cases, histopathology. In this setting, identification of liver disease accompanying a liver nodule helps distinction between benign nodules and metastatic malignant nodules from primary liver cancer, as recommended by scientific liver societies. Diagnostic algorithms for a liver nodule in patients with liver disease involve contrast CT scan, magnetic resonance imaging or contrast enhanced ultrasounds to show the typical neoplastic pattern of early arterial hyperenhancement wash-in followed by hypoenhancement in the late portal phase wash out. The flow charts developed by western societies utilize the discriminant criterion of tumor size i.e. the radiological diagnosis being endorsed in a nodule equal or greater than 1 cm whereas eastern societies rely on the recognition of a typical vascular pattern of the node, independently of size. Differential diagnosis should be obtained to differentiate liver related nodules like regenerative macronodules (more than 20% of the cases) and the less frequent intrahepatic cholangiocarcinoma (~2% of the cases) from liver disease unrelated nodules like hemangioma (~4%), neuroendocrine metastatic nodules (~1%) and focal nodular hyperplasia. In patients without liver disease, the most common liver nodules in the liver are hemangioma (~1.5%), focal nodular hyperplasia (0.03%) and hepatocellular adenoma (up to 0.004% in long term users of oral contraceptives). Optimization of management of patients with a liver nodule requires establishment of a multidisciplinary clinic.


REFERENCES

  1. Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, Greenlee RT, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 2012; 307: 2400-9.

  2. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-43.

  3. Ulahannan SV, Duffy AG, McNeel TS, Kish JK, Dickie LA, Rahma OE, McGlynn KA, et al. Earlier presentation and application of curative treatments in hepatocellular carcinoma. Hepatology 2014; 60: 1637-44.

  4. Bruix J, Sherman M. Management of Hepatocellular Carcinoma: An Update. Hepatology 2011; 53: 1020-2.

  5. Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4: 439-74.

  6. Marrero JA, Ahn J, Rajender Reddy K; American College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109: 1328-47.

  7. Sherman M, Colombo M. Hepatocellular carcinoma screening and diagnosis. Semin Liver Dis 2014; 34: 389-97.

  8. Manini MA, Sangiovanni A, Fornari F, Piscaglia F, Biolato M, Fanigliulo L, Ravaldi E, et al; Study Participants. Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma. J Hepatol 2014; 60: 995-1001.

  9. Forner A, Vilana R, Bianchi L, Rodríguez-Lope C, Reig M, García-Criado MA, Rimola J, et al. Lack of arterial hypervascularity at contrast-enhanced ultrasound should not define the priority for diagnostic work-up of nodules 2 cm. J Hepatol 2015; 62: 150-5.

  10. Kojiro M, Roskams T. Early hepatocellular carcinoma and dysplastic nodules. Semin Liver Dis 2005; 25: 133-42.

  11. Tremosini S, Forner A, Boix L, Vilana R, Bianchi L, Reig M, Rimola J, et al. Prospective validation of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in liver biopsies for diagnosis of very early hepatocellular carcinoma. Gut 2012; 61: 1481-7.

  12. Bridgewater J, Galle PR, Khan SA, Llovet JM, Park JW, Patel T, Pawlik TM, Gores GJ. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60: 1268-89.

  13. Rodríguez-Lope C, Sapisochin G, Gastaca M, Ortiz de Urbina J, López-Andujar R, Palacios F, Ramos E, et al. Intrahepatic cholangiocarcinoma (I-CC) or mixed hepatocellular– cholangiocarcinoma (HCC-CC) in patients undergoing liver transplantation. A Spanish case control multicenter study. Journal of Hepatology 2014; 58(Suppl. 1): S114-S115.

  14. Stoot JH, Coelen RJ, De Jong MC, Dejong CH. Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB (Oxford) 2010; 12(8): 509-22.

  15. Zucman-Rossi J, Jeannot E, Nhieu JT, Scoazec JY, Guettier C, Rebouissou S, Bacq Y, et al. Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology 2006; 43: 515-24.

  16. Yopp AC, Ostapoff KT, Singal AG, Mansour JC, Balch GC, Marrero JA, Schwarz R. Association of the establishment of multidisciplinary (MDC) hepatocellular carcinoma (HCC) clinic with clinical outcome. Journal of Clinical Oncology 2013; 31(Suppl.): 332.




2020     |     www.medigraphic.com