title: Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions.
abstract: OBJECTIVE
  We examined 103 cases over the last five years and discussed diagnosis and treatment of alpha-fetoprotein (AFP)-negative small hepatic lesions.
  
  
  BACKGROUND
  Small hepatic lesions (less than 2 cm in diameter) usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result.
  
  
  METHODS
  A total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography (DSA), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), contrast-enhanced ultrasound (CEUS), or positron emission tomography-computed tomography (PET-CT) based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires.
  
  
  RESULTS
  Hepatocellular carcinoma (HCC) diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively.
  
  
  CONCLUSIONS
  DSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.
authors.affiliation: Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing 100730, China.
authors.forename: Yiyao
authors.initials: Y
authors.lastname: Xu
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Yilei
authors.initials: Y
authors.lastname: Mao
authors.forename: Xinting
authors.initials: X
authors.lastname: Sang
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhao
authors.forename: Shunda
authors.initials: S
authors.lastname: Du
authors.forename: Haifeng
authors.initials: H
authors.lastname: Xu
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Sun
authors.forename: Huayu
authors.initials: H
authors.lastname: Yang
authors.forename: Tianyi
authors.initials: T
authors.lastname: Chi
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Yang
authors.forename: Shouxian
authors.initials: S
authors.lastname: Zhong
authors.forename: Jiefu
authors.initials: J
authors.lastname: Huang
keywords: Alpha-fetoprotein (AFP)-negative small hepatic lesions; contrast-enhanced ultrasound (CEUS); dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI); hepatectomy