title: Diagnostic workup of liver lesions: too long time with too many examinations.
abstract: OBJECTIVE
  Liver mass lesions are often detected incidentally. Subsequent imaging examinations and surveillance are not only expensive, but may also cause unnecessary concern to patients. The aim of this study was to evaluate retrospectively the possible delay in acquiring the diagnosis of liver mass lesions, and to estimate the number of imaging examinations performed during the diagnostic workup.
  
  
  METHODS
  The study comprised 200 patients with liver mass lesion of unknown etiology. The time needed from referral to final diagnosis was assessed. All imaging examinations and biopsy findings (if available) during the diagnostic workup were recorded.
  
  
  RESULTS
  Out of the 200 lesions, 133 were malignant, 65 with hepatocellular cancer and 26 with cholangiocarcinoma. All except one were diagnosed within 8 weeks. Of the 67 benign lesions, there were 20 focal nodular hyperplasias and 20 hemangiomas. For the benign lesions, in 37% the diagnostic workup took >8 weeks. Repeated examinations were more common in benign lesions; but often redundant in both benign and malignant conditions in retrospect analysis.
  
  
  CONCLUSIONS
  To confirm the diagnosis, benign lesions required more follow-up time and more repeated imaging examinations than malignant ones. A long surveillance for liver mass lesions in fear of malignancy seems not to be necessary, since virtually all malignant lesions were diagnosed within 8 weeks. Evaluating all lesions in a multidisciplinary team right from the beginning is advocated by a prospective study design.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital , Tampere , Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Irina
authors.initials: I
authors.lastname: Rinta-Kiikka
authors.forename: Sari
authors.initials: S
authors.lastname: Räty
authors.forename: Johanna
authors.initials: J
authors.lastname: Laukkarinen
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis*; D006391:Hemangioma / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: bile duct cancer; focal nodular hyperplasia; hepatic neoplasms; hepatocellular cancer