Systematic approach for benign liver lesions in non - cirrhotic livers

Focal liver lesions are increasingly diagnosed in non-cirrhotic livers with widespread use of imaging. Arriving at an accurate diagnosis is challenging. Management of indeterminate lesions is not clearly defined. This paper looks at 101 non - malignant cases on the initial assessment and the outcome after three years of follow up.

To assess the outcome of 101 benign liver lesions on initial assessment.

136 lesions in non-cirrhotic patients underwent triphasic CT(Computed Tomography )scan in all, MRI in 56 cases, biopsy in 5 patients and all discussed in multidisciplinary meeting. After initial evaluation 101/136 were benign or likely to be benign. These were divided as having benign asymptomatic lesions (n = 59), benign symptomatic lesions (n = 9), benign but indeterminate lesions (n = 33). Surgery was offered for symptomatic and potentially progressive lesions. Collective decision was taken in indeterminate lesions for surgery or follow up for three years.

Overall, 37% had haemangiomas, 24% had liver cysts, 8% had focal nodular hyperplasia (FNH), 5% had adenomas. 25% underwent surgery. These included 7/59 diagnosed lesions, nine symptomatic lesions and 8/33 indeterminate lesions. Of the 33 indeterminate lesions six turned out to be FNH after surgery. 24 lesions, which were followed up for three years, did not increase in size. None of the 101 benign lesions turned out to be malignant after surgery or follow- up.

Benign lesions can be diagnosed safely with currant imaging. Strong recommendation for follow up appears to be a safe strategy for indeterminate lesions.