title: Contrast-enhanced computed tomography and ultrasound-guided liver biopsy to diagnose dysplastic liver nodules in cirrhosis.
abstract: BACKGROUND
  Dysplastic nodules in cirrhosis herald a very high risk of transition to hepatocellular carcinoma. A better understanding of the relationships between dysplastic nodules and hepatocellular carcinoma development may help refining strategies of enhanced follow-up.
  
  
  METHODS
  All consecutive cirrhotics with a histologically proven de novo dysplastic nodule, were retrospectively identified and underwent alternating abdominal ultrasound and contrast-computed tomography every 3 months. An ultrasound-guided liver biopsy was the diagnostic gold standard, whereas surveillance and recall policies were according to current guidelines.
  
  
  RESULTS
  Among 36 patients with dysplastic nodule (21 low-grade, 15 high-grade, 17.4 ± 2.6mm), 17 (47%) showed arterial wash-in, 15 (42%) portal/venous hypodensity whereas 4 (11%) had neither pattern. During 6-128 (median 36) months, 21 patients developed a hepatocellular carcinoma at a rate of 13.8% per year, intranodular=8.7% vs extranodular=7.1% per year. Hepatocellular carcinoma occurred more frequently in high-grade than low-grade dysplastic nodules (32.2% vs 9.3% per year, p=0.0039); the maximum time to hepatocellular carcinoma transformation was 27 months for intranodular vs 67 months for extranodular tumours (p=0.025). No contrast-computed tomography pattern predicted neoplastic transformation of dysplastic nodules.
  
  
  CONCLUSIONS
  The histological examination of liver nodules in cirrhosis lacking the imaging hallmark of hepatocellular carcinoma improves both prognostication and outcome of surveillance, since it dictates the intensity of the radiological follow-up.
authors.affiliation: Centro AM e A Migliavacca for Liver Diseases, 1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy. massimo.iavarone@gmail.com
authors.forename: Massimo
authors.initials: M
authors.lastname: Iavarone
authors.forename: Matteo Angelo
authors.initials: MA
authors.lastname: Manini
authors.forename: Angelo
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
authors.forename: Laura Virginia
authors.initials: LV
authors.lastname: Forzenigo
authors.forename: Luca
authors.initials: L
authors.lastname: Di Tommaso
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Massimo
authors.initials: M
authors.lastname: Roncalli
authors.forename: Guido
authors.initials: G
authors.lastname: Ronchi
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002471:Cell Transformation, Neoplastic; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D061705:Image-Guided Biopsy / Q000379:methods*; D015994:Incidence; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D018084:Ultrasonography, Interventional