The natural history of hepatic macroregenerative nodules developing in cirrhotic patients during surveillance with ultrasound.

Abstract

e14631 Background: Nonmalignant liver nodules (LN) are identified during the surveillance with abdominal ultrasound ( US) of cirrhotic patients for the diagnosis of early hepatocellular carcinoma (HCC). The natural history of LN is poorly understood. Aim: To prospectively evaluate the course of de novo nonmalignant LN detected during surveillance of cirrhotic patients. Methods: Consecutive Child Pugh A cirrhotic patients under surveillance with histologically proven de novo nonneoplastic LN were studied. Nonmalignant LN were followed with repeat US every 3 months and contrast enhanced CT/MR every 6 months. Fine needle biopsy (FNB) was repeated in nodules with increased size or a modified vascular pattern suggesting neoplastic transformation. Results: 31 nonmalignant liver nodules were detected in 30 patients, mean age 65 years (43-84), 51 (74%) males. Twenty-eight LN were between 1-2 cm in size including 25 macro-regenerative nodules (MRN) and 3 low-grade dysplastic nodules (LGDN). During a mean follow-up of 21 (7-34) months, 3 LGDN, all with arterial enhancement, progressed to HCC after 18 and 24 months, 8 MRN disappeared (3 with arterial enhancement, 1 with portal wash-out, 4 with neither vascular feature), and 20 remained unchanged (8 with arterial enhancement 4 with portal wash-out, 8 with neither feature). Additional LN developed in 10 patients including 1 HCC, 7 MNR, 2 undefined. Overall the mean yearly incidence of HCC was 6.2%. Liver cell dysplasia was the only significant predictive factor of HCC development (p = 0.002). Conclusions: Mean yearly incidence of HCC in nonneoplastic de novo LN detected in cirrhotic patients under surveillance is 6.2% with dysplasia being the only significant predictor of neoplastic transformation. No significant financial relationships to disclose.