There is an emerging interest in managing incidental findings in the liver and pancreas [ 3 — 5 , 7 — 9 , 37 ]. Among cross-sectional imaging, MRI is considered the most reliable imaging method for classifying incidental liver lesions, especially after recent improvements, e.
However, even after combining different non-invasive imaging modalities, e. There were no statistical significant improvements with regard to the percentage of correct diagnosis over the investigated time periods.
Our data show a non significant decrease in surgical procedures between and in patients with histologically proven diagnosis of FNH. The apparent decrease of carried out surgical procedures does not necessarily represent a decrease in incidence of FNH, but only a decrease of patients who underwent surgical procedures for FNH.
The reason for the decrease of surgical interventions in FNH patients lies, in our opinion, in the more accurate and reliable diagnostic modalities. Percutaneous fine-needle biopsy represents another diagnostic possibility in the workflow for uncertain liver lesions. However, its significance is discussed controversially, as it is associated with an increased bleeding risk in hypervascularized lesions and a risk of peritoneal seeding in case of malignancy [ 2 — 7 , 19 — 21 ].
Apart from operative management strategies of symptomatic FNH, percutaneous radiological modalities have to be considered and include arterial embolization and radiofrequency ablation RFA , which have been published in a few case series [ 10 , 38 — 40 ]. However, up to date no randomized controlled trials exist comparing the outcome of surgical resection with percutaneous techniques. Of interest, the major limitation of these interventional techniques is the lack of post-procedural histology.
Therefore, these techniques should only be applied if a definitive diagnosis of FNH could be secured by preoperative imaging and biopsy-derived diagnosis [ 10 ]. Most incidentalomas are likely benign without or little clinical significance.
Committees have recently been formed to manage incidental findings on CT and consensus guidelines try to classify patients groups of high risk with hepatic and pancreatic lesions [ 8 , 9 , 28 , 37 ].
Certainly, special guidelines for benign liver lesions are needed to balance cost-intensive long-term follow ups by MRI against the risk of unnecessary operations associated with perioperative complications. We need to take in account not only improvements in radiological findings; due to ongoing improvements in liver surgery with decreased perioperative complications even major hepatic resections can be safely performed in experienced hepatobiliary centers [ 19 , 22 , 29 , 30 , 41 — 43 ].
In contrast to asymptomatic patients diagnosed with incidentalomas of the liver, 46 patients underwent liver surgery because of abdominal discomfort with nonspecific symptoms nausea, fatigue, decreased appetite, etc.
Although the evaluated symptoms represent typical complaints of patients with benign hepatic tumors, they are admittedly not specific for FNH. However, the symptoms listed in our questionnaire were chosen in support of similar studies evaluating QoL in patients with surgery for benign hepatic tumors and therefore seem suited to evaluate QoL postoperatively [ 30 , 31 ]. Abdominal pain as indication for surgery can be challenging, as it is difficult to provide assurances that symptoms will improve after surgery [ 22 , 30 ].
Therefore, liver resection should be considered only after exclusion of other causes for abdominal symptoms and if a relief of symptoms is expected after surgery. Only a few reports on QoL improvements after liver resection of benign liver tumors exist, with no sufficient data for FNH available [ 22 , 30 , 31 , 41 , 43 ].
Beside a decreased complication rate after liver surgery, long-term outcome represents an important factor for evaluating patients for surgery. Our study provides first evidence that QoL might improve in patients with symptomatic FNH after liver resection.
The mean patient self-reported pain levels had significantly decreased over time. Furthermore, significant improvements were noted not only in physical activities, but also in social and mental health. These improvements resulted in greater work productivity, increased energy level and better social functioning. Regarding the different types of surgical approaches, e. This is in contrast to previous studies by Kneurtz et al.
This controversy might be due to the fact that only patients scheduled for minor resections were evaluated for laparoscopic approaches in our cohort. In accordance with similar studies, patients undergoing laparoscopic liver resection reported a postoperative improvement of QoL of 2. The current study has several limitations that should be considered. In this context, the collection of data may be influenced by recall bias. For example, a possible concern might be that patients with better operative outcomes e.
This bias could lead to an overestimation of the postoperative improvement of QoL in our study. Therefore, if one may consider the complication rate as parameter for negative outcome or negative association of the surgical intervention by the patient, a similar complication rate might contradict the suggested recall bias. Another limitation might be that patients with the pre-existing diagnosis of a malignant tumor might feel more worried by the presence of a malignant tumor in the liver and postoperative benign diagnosis may have brought these patients more relief compared to patients without a cancer history.
Patients with a subjective uncertainty of malignancy had a non significant increase in QoL after hepatic surgery for FNH. However, all other patients with preoperative proven diagnosis of a benign tumor nature also showed an insignificant increase of QoL.
Therefore, we suggest that the histologically proven certainty of benign tumor nature may play an important role in QoL for patients, who are worried about the potential malignancy of the tumor; however, patients without worries about tumor malignancy also profited from the operation in our study. This study demonstrates that liver resection for benign liver tumors can be performed safely in specialized hepatobiliary centers.
Despite improvements in diagnostic modalities, there remain liver lesions that cannot be specified reliably by imaging. In case of symptomatic liver lesions, surgical resection should only be indicated in patients with tumor-specific symptoms.
Regarding our results, surgery for FNH is associated with marked improvements in patient-reported pain scores as well as other QoL domains. Patients with significant preoperative symptoms show the most benefit from surgical intervention. Focal nodular hyperplasia and hepatic adenoma: a review. Ann Hepatol. PubMed Google Scholar.
Focal nodular hyperplasia—a review of myths and truths. J Gastrointest Surg. Article PubMed Google Scholar. HPB Surg. Koea JB. Hepatic incidentaloma: the rule of tens. HPB Oxford. Article Google Scholar. Chiche L, Adam JP. Diagnosis and management of benign liver tumors.
Semin Liver Dis. Changes in the management of benign liver tumours: an analysis of patients. Liver masses: a clinical, radiologic, and pathologic perspective. Clin Gastroenterol Hepatol. Characteristics of common solid liver lesions and recommendations for diagnostic workup. World J Gastroenterol. J Am Coll Radiol. Focal nodular hyperplasia: a review of current indications for and outcomes of hepatic resection.
The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. Diagnosis and differential diagnosis of benign liver tumors and tumor-like lesions. Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium.
Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid-enhanced MRI characteristics. Magn Reson Imaging.
Imaging benign hepatocellular tumors: atypical forms and diagnostic traps. Diagn Interv Imaging. Palmucci S. Focal liver lesions detection and characterization: the advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol.
Differentiation of focal nodular hyperplasia from hepatocellular adenomas with low-mecanical-index contrast-enhanced sonography CEUS : effect of size on diagnostic confidence. Eur Radiol. Management of patients with benign liver tumours. Br J Surg. Indication for treatment and long-term outcome of focal nodular hyperplasia.
Assessment of the benefits and risks of percutaneous biopsy before surgical resection of hepatocellular carcinoma. If you want, you can also download image file to print, or you can share it with your friend via Facebook, Twitter, Pinterest, Google, etc. To see all meanings of FNH, please scroll down. The full list of definitions is shown in the table below in alphabetical order.
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