title: Changes in the management of benign liver tumours: an analysis of 285 patients.
abstract: OBJECTIVE
  Benign liver tumours (BLTs) are common and their management remains controversial. This study assesses the safety of a selective management approach.
  
  
  METHODS
  Patients with BLT were identified from an institutional database. Patients with simple cysts or an incidental BLT in the setting of metastasis or concomitant malignancy were excluded.
  
  
  RESULTS
  A total of 285 patients presenting during the period from January 1992 to December 2009 with haemangioma (53.0%), focal nodular hyperplasia (23.9%), adenoma (10.2%) or indeterminate/other lesions (13.0%) were evaluated. Of these, 117 patients (41.1%) underwent immediate resection and 168 patients (58.9%) were followed with serial imaging (median follow-up: 30 months). During observation, eight patients (4.8%) underwent resection for tumour growth, inability to exclude malignancy or symptoms; no patients demonstrated malignant transformation or tumour-related complications. During the study period, the number of BLTs evaluated and the proportion of patients observed increased from 129 BLTs of which 36.4% were observed in 1992-2002 to 156 BLTs of which 71.2% were observed in 2003-2009 (P < 0.001). Diagnostic uncertainty led to resection in 29.5% of patients during the earlier period, but in only 13.4% during the more recent 7 years (P < 0.05).
  
  
  CONCLUSIONS
  Asymptomatic BLTs without concern for malignancy or adenoma can be safely observed with minimal risk for misdiagnosis. Patients selected for observation rarely require resection or develop tumour-related complications.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Mezhir
authors.forename: Lindsay T
authors.initials: LT
authors.lastname: Fourman
authors.forename: Richard K
authors.initials: RK
authors.lastname: Do
authors.forename: Brian
authors.initials: B
authors.lastname: Denton
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D018248:Adenoma, Liver Cell / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D003560:Cysts / Q000175:diagnosis / Q000601:surgery; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome