Liver mass evaluation: Difference between revisions

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Latest revision as of 22:32, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

A hallmark feature in the evaluation of liver mass is the malignancy assessment. The evaluation approach of liver mass will mainly depend on the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as location, clinical features, and distribution may be helpful for the therapeutic management, surveillance, and follow-up of liver mass. Liver mass can be divided into 2 categories benign liver mass and malignant liver mass. Based upon these categories, complementary diagnostic studies which include PET/CT scan, MRI, non-surgical biopsy, and surgical resection are recommended.

Liver Mass Evaluation

The initial evaluation of liver mass, should include detailed medical history, physical examination, biochemical and blood tests (AFP levels, serology for hepatitis), and imaging studies.
The algorithm below summarizes the evaluation of solitary liver mass with history of cirrhosis or chronic HBV infection:^[1]^[1]^[2]^[3]^[4]^[5]

Solitary liver mass with cirrhosis or HBV

<1cm

>1cm

Contrast MRI

Atypical for HCC

Typical for HCC

Ultrasound in 3 months

Specific treatment

Stable

Abnormal growth or change in character

Repeat ultrasound in 3-5 months

MDCT(dynaminc contrast induced MRI

Abnormal growth or change in character

Atypical for HCC

Typical for HCC

Follow up with MDCT(dynaminc contrast induced MRI

CA19-9

Specific treatment

Normal

Elevated

Biopsy for specific diagnosis

H/O of cholangitis or cholistasis

Yes

No

Treat cholingitis/cholestasis
and check CEA19-9 levels again

Resection of lesion

Elevated

Normal

Resection of lesion

Biopsy of lesion

The algorithm below summarizes the evaluation of solitary liver mass without history of cirrhosis or chronic HBV infection:

Solitary liver mass without cirrhosis or HBV

Suspision of extrahepatic malignancy

Yes

No

Mets likely

Mets unlikely/Primary tumor

Biopsy to confirm

Check AFP levels

Elevated

Normal

MDCT(dynaminc contrast induced MRI)

Lesion size

<1cm

>1cm

Contrast MRI

Atypical for HCC

Typical for HCC

Ultrasound in 3 months

Specific treatment

Stable

Abnormal growth or change in character

Repeat ultrasound in 3-5 months

MDCT(dynaminc contrast induced MRI)

Abnormal growth or change in character

Atypical for HCC

Typical for HCC

Follow up with MDCT(dynaminc contrast induced MRI

CA19-9

Specific treatment

Normal

Elevated

Biopsy for specific diagnosis

H/O of cholangitis or cholistasis

Yes

No

Treat cholingitis/cholestasis
and check CEA19-9 levels again

Resection of lesion

Elevated

Normal

Resection of lesion

Biopsy of lesion

References

↑ ^1.0 ^1.1 Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
↑ Wilson SR, Burns PN (2001). "Liver mass evaluation with ultrasound: the impact of microbubble contrast agents and pulse inversion imaging". Semin. Liver Dis. 21 (2): 147–59. doi:10.1055/s-2001-15342. PMID 11436569.
↑ Liu PS (2015). "Liver Mass Evaluation in Patients Without Cirrhosis: A Technique-Based Method". Radiol. Clin. North Am. 53 (5): 903–18. doi:10.1016/j.rcl.2015.05.008. PMID 26321445.
↑ Bahirwani R, Reddy KR (2008). "Review article: the evaluation of solitary liver masses". Aliment. Pharmacol. Ther. 28 (8): 953–65. doi:10.1111/j.1365-2036.2008.03805.x. PMID 18643922.
↑ Lantinga MA, Gevers TJ, Drenth JP (2013). "Evaluation of hepatic cystic lesions". World J. Gastroenterol. 19 (23): 3543–54. doi:10.3748/wjg.v19.i23.3543. PMC 3691048. PMID 23801855.

[pmid22541698-1] 1.0 ^1.1 Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.

[pmid11436569-2] Wilson SR, Burns PN (2001). "Liver mass evaluation with ultrasound: the impact of microbubble contrast agents and pulse inversion imaging". Semin. Liver Dis. 21 (2): 147–59. doi:10.1055/s-2001-15342. PMID 11436569.

[pmid26321445-3] Liu PS (2015). "Liver Mass Evaluation in Patients Without Cirrhosis: A Technique-Based Method". Radiol. Clin. North Am. 53 (5): 903–18. doi:10.1016/j.rcl.2015.05.008. PMID 26321445.

[pmid18643922-4] Bahirwani R, Reddy KR (2008). "Review article: the evaluation of solitary liver masses". Aliment. Pharmacol. Ther. 28 (8): 953–65. doi:10.1111/j.1365-2036.2008.03805.x. PMID 18643922.

[pmid23801855-5] Lantinga MA, Gevers TJ, Drenth JP (2013). "Evaluation of hepatic cystic lesions". World J. Gastroenterol. 19 (23): 3543–54. doi:10.3748/wjg.v19.i23.3543. PMC 3691048. PMID 23801855.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Liver mass}}
-{{CMG}} {{AE}}{{MV}}
+{{CMG}}; {{AE}}{{MV}}
 ==Overview==
+A hallmark feature in the evaluation of liver mass is the [[malignancy]] assessment. The evaluation approach of liver mass will mainly depend on the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as location, clinical features, and distribution may be helpful for the therapeutic management, surveillance, and follow-up of liver mass. Liver mass can be divided into 2 categories [[benign]] liver mass and [[malignant]] liver mass. Based upon these categories, complementary diagnostic studies which include [[PET scan|PET/CT scan]], [[Magnetic resonance imaging|MRI]], non-surgical [[biopsy]], and surgical resection are recommended.
-A hallmark feature in the evaluation of liver mass is the malignancy assessment. The evaluation approach of liver mass will mainly depend in the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as: location, clinical features, and distribution may be helpful for the therapeutical management, surveillance, and follow-up of liver mass. Lung mass can be divided into 2 categories: benign liver mass and malignant liver mass. Based upon these categories, complementary diagnostic studies and management, include: PET/CT scan, MRI, non-surgical biopsy, and surgical resection.
 ==Liver Mass Evaluation==
-*The initial evaluation of liver mass, should include: detailed medical history, physical examination, biochemical and blood tests (AFP levels, serology for hepatitis), and imaging studies.
+*The initial evaluation of liver mass, should include detailed medical history, physical examination, biochemical and blood tests ([[Alpha-fetoprotein|AFP]] levels, [[serology]] for [[hepatitis]]), and [[imaging]] studies.
-*The algorithm below summarizes the initial liver mass evaluation according to medical history.<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref>
+*The algorithm below summarizes the evaluation of solitary liver mass '''with''' history of [[cirrhosis]] or chronic [[Hepatitis B virus|HBV]] infection:<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref><ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref><ref name="pmid11436569">{{cite journal |vauthors=Wilson SR, Burns PN |title=Liver mass evaluation with ultrasound: the impact of microbubble contrast agents and pulse inversion imaging |journal=Semin. Liver Dis. |volume=21 |issue=2 |pages=147–59 |year=2001 |pmid=11436569 |doi=10.1055/s-2001-15342 |url=}}</ref><ref name="pmid26321445">{{cite journal |vauthors=Liu PS |title=Liver Mass Evaluation in Patients Without Cirrhosis: A Technique-Based Method |journal=Radiol. Clin. North Am. |volume=53 |issue=5 |pages=903–18 |year=2015 |pmid=26321445 |doi=10.1016/j.rcl.2015.05.008 |url=}}</ref><ref name="pmid18643922">{{cite journal |vauthors=Bahirwani R, Reddy KR |title=Review article: the evaluation of solitary liver masses |journal=Aliment. Pharmacol. Ther. |volume=28 |issue=8 |pages=953–65 |year=2008 |pmid=18643922 |doi=10.1111/j.1365-2036.2008.03805.x |url=}}</ref><ref name="pmid23801855">{{cite journal |vauthors=Lantinga MA, Gevers TJ, Drenth JP |title=Evaluation of hepatic cystic lesions |journal=World J. Gastroenterol. |volume=19 |issue=23 |pages=3543–54 |year=2013 |pmid=23801855 |pmc=3691048 |doi=10.3748/wjg.v19.i23.3543 |url=}}</ref>
+<small>
 {{Familytree/start}}
-{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A01=Solitary liver mass with a history of cirrhosis or HBV infection}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A01=Solitary liver mass '''with''' [[cirrhosis]] or [[HBV]]}}
 {{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | |}}
+{{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|.| | | |}}
-{{familytree | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | B02 | | | |B01=<1cm|B02=>1cm}}
+{{familytree | | | | | | | | | | | | | | | B01 | | | | | | | | | | B02 | | | |B01=<1cm|B02=>1cm}}
-{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | | | }}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | }}
-{{familytree | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |!| | | | |C01=Contrast MRI}}
+{{familytree | | | | | | | | | | | | | | | C01 | | | | | | | | | | |!| | | | |C01=Contrast MRI}}
-{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | |}}
-{{familytree | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |!| | | | |}}
-{{familytree | | | | | | | | D01 | | | | | | | | | | | | D02 | | | | | | | |!| | | | |D01=Atypical for HCC|D02=Typical for HCC}}
+{{familytree | | | | | | | | D01 | | | | | | | | | | | | D02 | | | |!| | | | |D01=Atypical for [[HCC]]|D02=Typical for [[HCC]]}}
-{{familytree | | | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | |!| | | | | | | | | | | | | |!| | | | |!| | | | |}}
-{{familytree | | | | | | | | E01 | | | | | | | | | | | | E02 | | | | | | | |!| | | | |E01=Ultrasound in 3 months|E02=Specific treatment}}
+{{familytree | | | | | | | | E01 | | | | | | | | | | | | E02 | | | |!| | | | |E01=Ultrasound in 3 months|E02=Specific treatment}}
-{{familytree | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | |!| | | | | |}}
-{{familytree | | F01 | | | | | | | | | | F02 | | | | | | | | | | | | | | | |!| | | | | | |F01=Stable|F02=Abnormal growth or change in character}}
+{{familytree | | F01 | | | | | | | | | | F02 | | | | | | | | | | | |!| | | | | | |F01=Stable|F02=Abnormal growth or change in character}}
-{{familytree | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | |!| | | | | | | | | | | |!| | | | | | | | | | | | |!| | | | | |}}
-{{familytree | | G01 | | | | | | | | | | G02 |-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|'| | | | | |G01=Repeat ultrasound in 3-5 months|G02=MDCT(dynaminc contrast induced MRI}}
+{{familytree | | G01 | | | | | | | | | | G02 |-|-|-|-|-|-|-|-|-|-|-|'| | | | | |G01=Repeat ultrasound in 3-5 months|G02=MDCT(dynaminc contrast induced MRI}}
 {{familytree | | |!| | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | | |}}
 {{familytree | | H01 | | | | | H02 | | | | | | | | H03 | | | | |H01=Abnormal growth or change in character|H02=Atypical for HCC|H03=Typical for HCC}}
@@ Line 36: / Line 34: @@
 {{familytree | | | | J01 | | | | | | | | J02 | | | J01=Normal|J02=Elevated}}
 {{familytree | | | | |!| | | | | | | | | |!| | | | | |}}
-{{familytree | | | | J01 | | | | | | | | J02 | | | J01=Biopsy for specific diagnosis|J02=H/O of cholangitis or cholistasis}}
+{{familytree | | | | J01 | | | | | | | | J02 | | | J01=Biopsy for specific diagnosis|J02=H/O of [[cholangitis]] or [[cholistasis]]}}
 {{familytree | | | | | | | | | | | | | | |!| | | | | |}}
 {{familytree | | | | | | | | | | |,|-|-|-|^|-|-|-|.| |}}
 {{familytree | | | | | | | | | | K01 | | | | | | K02 | |K01=Yes|K02=No}}
 {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}
-{{familytree | | | | | | | | | | L01 | | | | | | L02 | | |L01=Treat cholingitis/cholestasis<br>and check CEA19-9 levels again|L02=Resection of lesion}}
+{{familytree | | | | | | | | | | L01 | | | | | | L02 | | |L01=Treat [[cholingitis]]/[[cholestasis]]<br>and check [[CEA19-9]] levels again|L02=Resection of lesion}}
 {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| |}}
 {{familytree | | | | | | M01 | | | | | | M02 | | M01=Elevated|M02=Normal}}
@@ Line 47: / Line 45: @@
 {{familytree | | | | | | N01 | | | | | | N02 | | | N01=Resection of lesion|N02=Biopsy of lesion}}
 {{familytree/end}}
+</small>
+* The algorithm below summarizes the evaluation of solitary liver mass '''without''' history of [[Cirrhosis CT|cirrhosis]] or chronic [[Hepatitis B virus|HBV]] infection:
+<small>
+{{Familytree/start}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | A01=Solitary liver mass '''without''' [[cirrhosis]] or [[HBV]]}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | B01 | | | | |B01=Suspision of extrahepatic malignancy}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | |}}
+{{familytree | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | |}}
+{{familytree | | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | C02 | | | |C01=Yes|C02=No}}
+{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| |}}
+{{familytree | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | |!| |}}
+{{familytree | | | | | | | | | D01 | | | | | | | | | D02 | | | | | | | | |!| | |D01=[[Metastasis|Mets]] likely|D02=Mets unlikely/Primary tumor}}
+{{familytree | | | | | | | | | |!| | | | | | | | | | |!| | | | | | | | | |!| | |}}
+{{familytree | | | | | | | | | E01 | | | | | | | | | E02 |-|-|-|-|-|-|-|-|'| | |E01=Biopsy to confirm|E02=Check [[AFP]] levels}}
+{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|.|}}
+{{familytree | | | | | | | | | | | F01 | | | | | | | | | | F02 | | | F01=Elevated|F02=Normal|}}
+{{familytree | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | |}}
+{{familytree | | | | | | | | | | | G01 | | | | | | | | | | G02 | | | | | |G01=MDCT(dynaminc contrast induced MRI)|G02=Lesion size}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | }}
+{{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|.| | | |}}
+{{familytree | | | | | | | | | | | | | | | B01 | | | | | | | | | | B02 | | | |B01=<1cm|B02=>1cm}}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | }}
+{{familytree | | | | | | | | | | | | | | | C01 | | | | | | | | | | |!| | | | |C01=Contrast MRI}}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |!| | | | |}}
+{{familytree | | | | | | | | D01 | | | | | | | | | | | | D02 | | | |!| | | | |D01=Atypical for [[HCC]]|D02=Typical for [[HCC]]}}
+{{familytree | | | | | | | | |!| | | | | | | | | | | | | |!| | | | |!| | | | |}}
+{{familytree | | | | | | | | E01 | | | | | | | | | | | | E02 | | | |!| | | | |E01=Ultrasound in 3 months|E02=Specific treatment}}
+{{familytree | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | F01 | | | | | | | | | | F02 | | | | | | | | | | | |!| | | | | | |F01=Stable|F02=Abnormal growth or change in character}}
+{{familytree | | |!| | | | | | | | | | | |!| | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | G01 | | | | | | | | | | G02 |-|-|-|-|-|-|-|-|-|-|-|'| | | | | |G01=Repeat ultrasound in 3-5 months|G02=MDCT(dynaminc contrast induced MRI)}}
+{{familytree | | |!| | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | | |}}
+{{familytree | | H01 | | | | | H02 | | | | | | | | H03 | | | | |H01=Abnormal growth or change in character|H02=Atypical for [[HCC]]|H03=Typical for [[HCC]]}}
+{{familytree | | |!| | | | | | |!| | | | | | | | | |!| | | |}}
+{{familytree | | I01 | | | | | I02 | | | | | | | | I03 | | |I01=Follow up with MDCT(dynaminc contrast induced MRI|I02=CA19-9|I03=Specific treatment}}
+{{familytree | | | | | | | | | |!| | | | | | | | | | | | }}
+{{familytree | | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
+{{familytree | | | | J01 | | | | | | | | J02 | | | J01=Normal|J02=Elevated}}
+{{familytree | | | | |!| | | | | | | | | |!| | | | | |}}
+{{familytree | | | | J01 | | | | | | | | J02 | | | J01=[[Biopsy]] for specific diagnosis|J02=H/O of [[cholangitis]] or [[cholistasis]]}}
+{{familytree | | | | | | | | | | | | | | |!| | | | | |}}
+{{familytree | | | | | | | | | | |,|-|-|-|^|-|-|-|.| |}}
+{{familytree | | | | | | | | | | K01 | | | | | | K02 | |K01=Yes|K02=No}}
+{{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}
+{{familytree | | | | | | | | | | L01 | | | | | | L02 | | |L01=Treat [[cholingitis]]/[[cholestasis]]<br>and check [[CEA19-9]] levels again|L02=[[Resection]] of lesion}}
+{{familytree | | | | | | |,|-|-|-|^|-|-|-|.| |}}
+{{familytree | | | | | | M01 | | | | | | M02 | | M01=Elevated|M02=Normal}}
+{{familytree | | | | | | |!| | | | | | | |!| | | }}
+{{familytree | | | | | | N01 | | | | | | N02 | | | N01=[[Resection]] of lesion|N02=[[Biopsy]] of lesion}}
+{{familytree/end}}
+</small>
+==References==
+{{Reflist|2}}
-==References==
-{{reflist|2}}
- [[Category:Up-To-Date]]
-[[Category:Oncology]]
 [[Category:Medicine]]
+[[Category:Gastroenterology]]
 [[Category:Hepatology]]
-[[Category:Gastroenterology]]
+[[Category:Oncology]]
+[[Category:Up-To-Date]]
 [[Category:Surgery]]

Liver mass evaluation: Difference between revisions

Latest revision as of 22:32, 29 July 2020

Overview

Liver Mass Evaluation

References

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