Introduction Focal liver lesions are common incidental findings and the differential diagnosis includes benign and malignant conditions. Cross sectional imaging and review in multidisciplinary team (MDT) is usually sufficient to obtain accurate diagnosis and biopsy/resection is reserved for indeterminate cases. We describe the nature of benign focal liver lesions discussed at a regional HPB MDT and determine the frequency of missed or inaccurate diagnoses.
Method Our regional MDT serves a population of 2 million. We obtained records of all liver lesions referred for discussion between 2007 and 2013. Cases where the initial diagnosis was that of a benign liver lesion were selected and patient demographics, mode of presentation, background liver disease, diagnosis, management and follow up data were collected. We also analysed the cases where the initial diagnosis was subsequently changed to either a new benign or a malignant diagnosis.
Results 245 cases were identified (males 32.2%; median age 54; range 16–88). 173 lesions were discovered as incidental findings, 54 patients were symptomatic and 16 cases had abnormal liver function tests leading to their presentation. 2 cases were diagnosed as a part of routine HCC surveillance. 128 patients had background liver disease (18 alcohol related and 110 non-alcohol related liver diseases). Haemagioma and Focal nodular hyperplasia (FNH) were the most common diagnoses (Table 1). 10 patients had two or more diagnoses.
The overall 1 year survival for all cases was 99.6%.
236 cases (96.3%) were given a final benign diagnosis. Only 18 cases were identified where there was a change in initial diagnosis. The average number of months before the new diagnosis was made was 9.5 months (median 9 months, range 2–30 months).
A new diagnosis of malignant lesion was made in 9 cases (3. 7%) which lead to a change in their management. Of these patients, 4 were deceased at the time of writing giving a median survival of 27.7 months (range 4–48 months) since first presentation to our MDT and 20.4 months (range 2–38 months)since revision of their original benign diagnosis.
Univariate analysis finds that age is higher (63 v 54; p = 0.008) and presence of background liver disease more common (66.7% v 15.4%; p = 0.001) in those that subsequently had a malignant diagnosis. Multivariate analysis confirmed that both age and background liver diseases are independent predictors of a subsequent malignant diagnosis.
Conclusion This study highlights the value of an MDT approach in the accuracy of diagnosing benign liver lesions (96.3%) and advocates this practice to continue. Additional care should be taken to exclude malignancy in older patients with background chronic liver disease.
Disclosure of interest None Declared.
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