Incidentally Detected Focal Liver Lesions - A Common Clinical Management Dilemma Revisited.
BACKGROUND
Detection of asymptomatic focal liver lesions (FLL) is increasing because of a widespread use of modern radiologic imaging. Most of these lesions are benign, though malignancy often has to be ruled out, which is posing a diagnostic challenge.


OBJECTIVE
To critically evaluate our treatment strategy in the context of recently published American College of Gastroenterology (ACG) guidelines.


METHODS
The medical records of patients who underwent surgery for asymptomatic, incidentally detected FLL from 2005-2012 were reviewed. Primary end-points were the congruence of suspected diagnosis and final pathology, as well as the identification of predictors of malignancy. A systematic review was undertaken to help define a standardized management.


RESULTS
Eighty patients, 37 male and 43 female with a mean age of 57 years (range=16-83) were included, harboring 39 (49%) malignant and 41 (51%) benign, asymptomatic hepatic lesions. Hepatocellular carcinoma (HCC) (n=24) represented most of malignant FLL, followed by cholangiocellular carcinoma (CCC) (n=10), whereas focal nodular hyperplasia (FNH) (n=19) and liver hemangioma (n=7) were the predominant benign entities. Fifty-one patients (64%) had a correct preoperative diagnosis, while patients with FNH were most commonly misdiagnosed (53%). We identified age (p<0.001) and male sex (p=0.013) as risk factors for malignancy in an asymptomatic FLL.


CONCLUSIONS
Despite recent technical advances of the modern radiology setting a correct preoperative diagnosis in an asymptomatic FLL remains challenging. Male gender and old age seem to correlate with malignancy. In the absence of biomarkers and evidence-based guidelines, a multidisciplinary approach in an experienced tertiary referral center is recommended for an optimized individual management.
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Alexander
A
Semaan
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Vittorio
V
Branchi
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Anna-Lena
AL
Marowsky
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Martin
M
VON Websky
Department of Radiology, University of Bonn, Bonn, Germany.
Patrick
P
Kupczyk
Department of Radiology, University of Bonn, Bonn, Germany.
Simon Jonas
SJ
Enkirch
Department of Radiology, University of Bonn, Bonn, Germany.
Guido
G
Kukuk
Department of Radiation Oncology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany.
Edwin
E
Bölke
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Burkhard
B
Stoffels
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Jörg C
JC
Kalff
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Nico
N
Schäfer
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany.
Philipp
P
Lingohr
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany hanno.matthaei@ukb.uni-bonn.de.
Hanno
H
Matthaei
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D004444:Echinococcosis, Hepatic / Q000628:therapy; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000628:therapy; D006801:Humans; D033162:Incidental Findings; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy*; D008113:Liver Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Incidentaloma; biomarkers; focal liver lesion