title: Focal nodular hyperplasia: a review of current indications for and outcomes of hepatic resection.
abstract: BACKGROUND
  Focal nodular hyperplasia (FNH) is a common benign disease of the liver with no recognized potential for malignant transformation. The term describes an entity of lobular proliferation of normally differentiated hepatocytes, frequently around a central fibrous scar. Two key issues influence surgical decision making in FNH: diagnostic certainty, and symptomatic assessment.
  
  
  METHODS
  A systematic review of studies reporting hepatic resections of FNH was performed. Indications and outcomes in adult populations were examined with a focus on diagnostic workup, patient selection and operative mortality and morbidity.
  
  
  RESULTS
  Diagnostic modalities in the majority of studies involved ultrasound and computed tomography. Fewer than half employed magnetic resonance imaging (MRI). In instances in which MRI was not available, diagnostic accuracy was inferior.
  
  
  CONCLUSIONS
  Percutaneous biopsy should be avoided to prevent the risk for tumour seeding. Patients presenting with asymptomatic definitive FNH can be safely managed conservatively. In symptomatic patients surgical resection is a safe and effective treatment for which acceptable rates of morbidity (14%) and zero mortality are reported. However, evidence of symptom resolution is reported with conservative strategies. Diagnostic uncertainty remains the principal valid indication for FNH resection, but only in patients in whom contrast-enhanced MRI forms part of preoperative assessment.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, UK.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Navarro
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Lamb
authors.forename: Adam
authors.initials: A
authors.lastname: Brooks
authors.forename: Iain C
authors.initials: IC
authors.lastname: Cameron
mesh_terms: D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome