title: An indeterminate nodule in the cirrhotic liver discovered by surveillance imaging is a prelude to malignancy.
abstract: BACKGROUND
  Surveillance imaging often shows indeterminate lesions in the cirrhotic liver, which may represent early hepatocellular carcinoma (HCC), dysplastic or regenerative nodules, or vascular shunts. The risk of HCC after identification of an indeterminate nodule is not well described.
  
  
  METHODS
  We identified 252 patients with cirrhosis and at least one indeterminate nodule discovered on surveillance imaging over a 4-year period. The incidence of HCC development within 2 years of nodule identification was measured along with baseline risk factors associated with developing HCC.
  
  
  RESULTS
  The incidence of HCC in this population was 21% (53 of 252), and risk factors associated with HCC included chronic viral hepatitis, male gender, and low platelet count. The median time from identification of an indeterminate nodule to diagnosis of HCC was 2.7 months. Patients with indeterminate nodules who developed HCC were more likely have to have an indeterminate nodule with arterial enhancement.
  
  
  CONCLUSIONS
  The 2-year incidence of HCC in the setting of cirrhosis and an indeterminate nodule discovered by surveillance imaging may be as high as one in five persons. Early follow-up imaging, biopsy, or empiric treatment should be considered for those at higher risk. Further, this population is well suited for early detection biomarker and chemoprevention studies.
authors.affiliation: Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
authors.forename: Eliza W
authors.initials: EW
authors.lastname: Beal
authors.forename: Scott
authors.initials: S
authors.lastname: Albert
authors.forename: Megan
authors.initials: M
authors.lastname: McNally
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Shirley
authors.forename: James
authors.initials: J
authors.lastname: Hanje
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: Sylvester M
authors.initials: SM
authors.lastname: Black
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: hepatic cirrhosis; hepatocellular cancer; liver neoplasms