title: Impact on liver cancer treatment of a first erroneous diagnosis of hemangioma.
abstract: BACKGROUND
  Most liver hemangioma (HA) diagnoses are presumptive and based on radiological features and growth trend. The goal of this study was to analyze the impact of a false diagnosis of hemangioma upon the overall therapeutic course and upon the prognosis of a liver malignancy.
  
  
  METHODS
  Twenty-eight patients with liver cancer who were observed in the period 2001-2007 after an initial erroneous diagnosis of HA were retrospectively evaluated. We studied their radiological workup after blind revision of the images by two radiologists with specific expertise in liver imaging, analyzing the relationship between overall management and center volume, mean delay from the first test to the curative treatment, and clinical consequences of this diagnostic mistake.
  
  
  RESULTS
  The diagnosis of false HA occurred in a low-volume center (LVC) in 75 % of cases. A specific risk for liver cancer was present in 71.4 % of patients. US gave a false diagnosis of HA in 25/27 patients, a CT scan in 18/25 patients, and MRI in 6/16 patients. The final diagnosis was reached with a mean delay of 22 months. Liver resection was possible in 22 patients; in the 17 hepatocellular carcinoma cases, the survival rate was 69.4 % at 5 years after the first observation.
  
  
  CONCLUSIONS
  A false diagnosis of HA in the presence of malignancy is not rare nowadays and significantly reduces the chances of cure. In situations at risk of having the error occur (poor technical quality of imaging, low specific experience, doubtful diagnosis, and high-cancer-risk patient), the rationale approach is to discuss the case with a multidisciplinary team skilled in the field of liver cancer.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, P. le Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baiocchi
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Sarah
authors.initials: S
authors.lastname: Molfino
authors.forename: Luigi
authors.initials: L
authors.lastname: Grazioli
authors.forename: Lucio
authors.initials: L
authors.lastname: Olivetti
authors.forename: Laura
authors.initials: L
authors.lastname: Romanini
authors.forename: Eleonora
authors.initials: E
authors.lastname: Frassi
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006391:Hemangioma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014463:Ultrasonography