Teaching Points (Liver Lesion)
- The great majority of incidentally-detected liver nodules are benign
- Even in patients with known extrahepatic primary malignancy, small liver lesions, if single or very few in number, are more likely to be benign than malignant.
- If the patient has a known primary malignancy, further imaging is needed if management will be affected.
- If there is a high risk of metastatic disease, image-guided fine needle aspiration (FNA) biopsy
- If there is a low risk of malignancy, follow-up imaging may be the chosen course
- If there is an intermediate risk, further imaging such as PET scan, MRI or FNA may be indicated
- If there are risk factors for primary hepatic malignancy (hepatocellular carcinoma - HCC);
- Lesions < 1cm are usually followed by serial imaging
- If the lesion(s) is hypervascular on one imaging modality (for lesions >2cm) or on two modalities (1-2cm) and/or the alpha-fetoprotein is raised, management should be for HCC
- The use of biopsy in suspected HCC is controversial due to the risk of needle tract seeding, particularly if the patient is a candidate for liver transplantation
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