Sonographic diagnosis of solitary solid liver nodules in cancer patients

The purpose of this study was to analyse the sonographic patterns of solitary solid liver lesions in cancer patients and to evaluate the diagnostic accuracy of ultrasound alone and in combination with other techniques (liver function tests, histology). A total of 422 solitary solid liver lesions (SSLL) were diagnosed by ultrasound in cancer patients; 197 lesions were benign and 225 malignant. The predominant aetiology for hypoechoic SSLL (128 cases) was metastasis (112 cases), whereas most hyperechoic SSLL (265 cases) were haemangiomas (155 cases) rather than a metastasis (86 cases). The 29 isoechoic SSLL included 27 metastases and 2 benign lesions. A halo was found to be highly predictive of malignancy (97%-100%). The positive predictive value for malignancy of an SSLL was very high when the results of liver function tests were abnormal (97%-100%). In our experience, histological proof is unnecessary in the majority of liver lesions in cancer patients.