Characteristics of common solid liver lesions and recommendations for diagnostic workup

• Published in: World journal of gastroenterology : WJG 2009-07, Vol.15 (26), p.3217-3227
• Main Authors: Assy, Nimer, Nasser, Gattas, Djibre, Agness, Beniashvili, Zaza, Elias, Saad, Zidan, Jamal
• Format: Article
• Language: English
• Subjects: Algorithms; Biomarkers, Tumor - metabolism; Biopsy; Biopsy, Fine-Needle; Diagnostic Imaging - methods; Humans; Incidental Findings; Liver Cirrhosis - pathology; Liver Neoplasms - diagnosis; Liver Neoplasms - pathology; Review; 不确定性; 临床应用; 成像方法; 磁共振成像; 肝脏病变
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.3217

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging （MRI）, previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma （the most likely; a solid liver lesion in a cirrhotic liver） and hemangioma （generally presenting as a mass in a non-cirrhotic liver）. Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.