Hepatic incidentaloma: the rule of tens

Hepatic incidentalomas (HI) are asymptomatic lesions detected incidentally during investigations for other pathologies. This prospective series outlines the management and outcomes of 121 HI managed over 7 years.

Data were recorded prospectively on 121 patients referred between 2003 and 2010 for assessment of HI out of 1081 patients referred for a hepatic resection. Patients were reviewed in multidisciplinary meetings and investigated with tumour markers and radiological investigations. HI were classified as hypo- or hypervascular depending on arterial phase CT scan findings. Univariate and multivariate analysis was performed to define predictive factors for malignancy.

Forty HI were hypovascular, 35 were benign (18 cysts, 12 focal fatty sparing, 1 fetal lobulation and 4 solitary necrotic nodules) and 5 cholangiocarcinomas (all resected)]. Eighty-one HI were hypervascular, 72 were benign [40 focal nodular hyperplasia (FNH), 8 adenoma and 24 hemangiomas) and 9 cancers (5 HCC, 4 metastases: 7 resected). Male gender [relative risk (RR) 2.70, confidence interval (CI) 1.69-3.51], age >45 years (RR 3.15, CI 2.71-3.89), tumour diameter >4 cm (RR 3.35, CI 3.13-4.01) and late (8 min) enhancement on magnetic resonace imaging (MRI) (RR 4.15, CI 3.01-4.79) were predictive of malignancy.

HI constitute 10% of practice volume. 10% of hyper and hypovascular incidental lesions are malignant. Most can be treated aggressively after diagnosis.