Focal ultrasound lesions in liver cirrhosis diagnosed as regenerating nodules by fine-needle biopsy

Abstract

In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.

Management of adenomatous hyperplastic nodules in the cirrhotic liver: US follow-up or percutaneous alcohol ablation?

“…Indeed the evolution of 10 AHNs into HCC was demonstrated in a study on 12 nodules during a period of observation in the range of 3-22 months, with a mean of 10.2 months [8]. However, in another study [7] in a series of 17 AHNs, no case of malignant transformation was observed after a long follow-up period (13-51 months).…”

“…Different selection criteria may explain such findings: in the first series [8], as well as in our retrospective study, all focal lesions without a clear-cut pathological diagnosis of malignancy were taken into account, whereas in the second series [7], nodules showing variable atypical changes were classified as "borderline lesions" and consequently excluded from the study.…”

“…No local recurrences were observed after a mean follow-up period of 16.9 months. PEI should therefore be considered mandatory in the management of AHNs.Key words: Liver, cirrhosis-Liver, neoplasmsLiver neoplasms, therapy --Liver neoplasms, US.Adenomatous hyperplastic nodules (AHNs) are now detected in cirrhotic livers with increased frequency, as a consequence of the widespread use of ultrasonography (US) in patients with chronic liver disease [1][2][3].AHNs are strongly suspected of being a precancerous condition of hepatocellular carcinoma (HCC)Address offprint requests to: Riccardo Lencioni, M.D., Department of Radiology, University of Pisa, Via Roma 67, 1-56100 Pisa, Italy and even though its natural history is not yet fully known, contradictory data can be found in the literature [4][5][6].Consequently, the management of AHNs is also controversial: while in most cases these lesions are merely followed with US and fine-needle biopsy (FNB), some authors recommend surgical resection [7][8][9].Percutaneous ethanol injection (PEI) has recently been proposed as a viable therapeutic alternative in the management of AHNs [10].Considering the lack of standardization in this field, we recently designed a retrospective study including all AHNs exhaustively followed in our center by means of US and FNB, before undertaking a prospective study aimed to further assess the results of the percutaneous alcohol ablation of these lesions. …”

Fine Needle Aspiration Biopsy for Improving the Diagnostic Accuracy of Cut Needle Biopsy of Focal Liver Lesions

“…In the presence of focal liver lesions in patients with cirrhosis, the possibility of a diagnosis of hepatocellular carcinoma should be considered, especially in patients who undergo screening by ultrasound and serum α-fetoprotein determination every 6 months. 2,12 Recently the European Association for the Study of the Liver 13 (EASL) suggested that for cirrhotic patients with a focal liver lesion > 2 cm in diameter compatible with hepatocellular carcinoma and identified by at least two imaging techniques it would not be necessary to perform cytological and/or histologic confirmation, with the imaging methods sufficient for the diagnosis of hepatocellular carcinoma. EASL 13 also suggested that punctures be limited to only patients with liver nodules < 2.0 cm for the differentiation between hepatocellular carcinoma and regeneration nodules.…”

Triple-phase multidetector computed tomography:an evaluation of hepatic space occupying lesion in cirrhotic patients

“…Caturelli showed that 69% of new nodules in a cirrhotic liver are malignant. 19 Moreover, liver cell dysplasia is found in 60% of cirrhotic livers containing hepatocellular carcinoma and in only 10% of non-cirrhotic livers.…”