Benign Liver Lesions Research Articles

Diagnostic effect of shear wave elastography imaging for differentiation of malignant liver lesions: a meta-analysis

BackgroundShear wave elastography (SWE) imaging have been proposed for characterization of focal liver lesions. We conducted a meta-analysis to evaluate the accuracy and clinical utility of SWE imaging for differentiation of malignant and benign hepatic lesions.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were systematically reviewed to search for studies published between January 1, 1990, and November 30, 2018. The studies published in English relating to the evaluation the diagnostic accuracy of SWE imaging for distinguishing malignant and benign liver lesions were retrieved and examined for pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios, using bivariate random-effects models. The hierarchical summary receiver operating characteristic (HSROC) curve was estimated to assess the SWE imaging accuracy. The clinical utility of SWE imaging for differentiation of malignant liver lesions was evaluated by Fagan plot.ResultsA total of 15 studies, involving 1894 liver lesions in 1728 patients, were eligible for the meta-analysis. The pooled sensitivity and specificity for identification of malignant liver lesions were 0.82 (95% CI: 0.77–0.86) and 0.82 (95% CI: 0.76–0.87), respectively. The AUC was 0.89 (95% CI: 0.86–0.91). When the pre-test probability was 50%, after SWE imaging measurement over the cut-off value (positive result), the corresponding post-test probability for the presence of malignant liver lesions was 82%; the post-test probability was 18% after negative measurement.ConclusionsSWE imaging showed high sensitivity and specificity in differentiating malignant and benign liver lesions and may be promising for noninvasive evaluation of liver lesions.Trial registrationThe review was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42018104510.

Abstract No. 497 Deep learning for differentiation of benign and malignant solid liver lesions on ultrasonography

Ultrasound-guided liver biopsy is commonly performed by interventional radiologists to diagnose solid liver lesions. However, the procedure is invasive and carries the risk of infection and bleeding. In this study, we used deep learning to differentiate benign from malignant focal solid liver lesions based on their appearance on routine abdominal ultrasound. A ResNet50-based neural network was fine-tuned using pre-trained weights on ImageNet. Patients who had abdominal ultrasound from 2014-2018 with liver code C2-C5 on Code Abdomen, an institutional lesion categorization system for abdominal organs on cross-sectional imaging modeled after BI-RADS, were included (Table 1). Non-cystic liver lesions with definite diagnosis by histopathology or MRI were included. Our dataset was split into training and validation sets by patient and augmented in real-time with zoom, skew, and flip transformations during training. Subgroup analysis of category 3 and 4 lesions (uncertain diagnosis set) was performed. Accuracy of the final model was compared with expert interpretation. Among the 410 patients who met the inclusion criteria, there were 521 images of individual lesions, of which 170 were malignant and 351 were benign. Our training set had 419 lesions and our validation set had 102 lesions. Our model achieved a validation accuracy of 83.3% compared to expert accuracy of 77.5% and 60.8%, respectively. The model had an ROC AUC of 0.83, sensitivity of 0.82, and specificity of 0.84. For the uncertain diagnosis set, our model achieved a validation accuracy of 85.1% compared to expert accuracy of 74.5% and 61.7%, respectively. The model had an ROC AUC of 0.78, sensitivity of 0.91, and specificity of 0.67. Deep learning distinguished benign from malignant ultrasound-captured solid liver lesions with a high accuracy compared to expert radiologists and can better triage patients for biopsy, particularly those at high risk or with multiple lesions.Table 1CategoryDescriptionBenign:MalignantBiopsy:MRI DiagnosisC2Benign157:01:15C3Indeterminate113:186:125C4Suspicious10:3416:28C5Highly suspicious2:7533:45 Open table in a new tab

CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases.

IntroductionLiver metastases from neuroendocrine tumors in multiple endocrine neoplasia syndrome are common (75%) and significantly impairs the prognosis. Characterisation of liver lesions in these patients is challenging, as liver metastases are difficult to differentiate from benign liver lesions such as haemangioma.MethodsIn this study we aimed to characterize the radiological findings of hepatic metastases in MEN patients. The findings of contrast-enhanced CT were considered for the main diagnosis. We retrospectively evaluated 25 patients with MEN-syndrome (10 MEN1/ 15 MEN2) including 11 men and 14 women between 28–62 years of age.ResultsLiver metastases (48%, 12/25) and hemangioma (40%, 10/25) were the most common liver lesions among our patients. The most common primary tumors in our MEN1 and MEN2 patients with liver metastases were of pancreatic neuroendocrine tumor (70%, 7/10) und medullary thyroid carcinoma (100%, 15/15) origin, respectively. CT-characteristics were grouped into three main categories, depending on contrast dynamics. The majority of hepatic metastases (75%, 14/25) are presented as multiple lesions with a slow growth in an average 5 years of follow-up-period. We were able to find a common CT pattern and categorise these for each MEN-syndrome. Hepatic metastases in MEN1 presented commonly a blurred arterial enhancement with a low portal venous enhancement and less frequently a prominent enhancement in the arterial phase, which mimics the classical haemangioma. In MEN2 the liver metastases exhibited disseminated mixed hyper- and hypo-enhanced lesions in CT-scans. Moreover, lesion calcifications are pathognomonic in MEN2. The main limitation of this study is the missing histopathological confirmation in the majority of cases.ConclusionsIn this retrospective imaging study, we were able to categorise and find a common CT pattern for hepatic lesions in patients with MEN-syndrome. In order to differentiate these lesions sufficiently, a combination of a 3-phasic CT-scan with US is required. Other liver specific imaging modalities (MRI, CEUS, SMS-PET/CT) should complement the diagnosis in individual cases.

Application of indocyanine green fluorescence imaging in laparoscopic liver surgery

Objective To study the clinical use of indocyanine green (ICG) fluorescence imaging in laparoscopic liver surgery. Methods The clinical and pathological data of 68 patients who underwent la-paroscopic hepatectomy using the ICG fluorescence imaging technique during the study period from September 2016 to October 2018 in Zhongnan Hospital, Wuhan University were retrospectively analyzed. Analysis was carried out on the surgical methods, fluorescence navigation methods, ICG injection time and dose, tumor characteristics, and pathological studies of the resected specimens. Results Of 68 patients, 3 patients were converted to open surgery, and the remaining 65 patients completed the ICG fluorescence laparoscopic hepatectomy. Thirty-two of these 65 patients underwent ICG fluorescent guided laparoscopic anatomical resection of lower hepatic segment / hepatic hemilivers (positive staining in 17 patients, negative staining in 15 patients), with 19 patients successfully staining with ICG(19 / 32, 59.4%). Postoperative histopathology showed primary hepatic solid tumors (n=31), secondary liver tumors (n=12), hepatic cysts (n=4), hepatic hemangiomas (n=5), hepatolithiasis (n=12) and hepatic focal nodular hyperplasia (n=1). These lesions were combined with hepatitis B liver fibrosis in 29 patients. Conclusions ICG fluorescence imaging positively impacted on laparoscopic liver surgery. Proper preoperative ICG injection was helpful for the identification, localization and intraoperative surgical guidance of tumors, especially for patients with deep-seated and central tumors. As a consequence, oncological and surgical safety of laparoscopic liver surgery was improved. Targeted visualization of liver segments and surgical navigation using intraoperative ICG injections facilitated accurate and precise resection of anatomical liver segments or hemi-hepatectomies. The use of intraoperative ICG fluorescence technology for hepatic hemangioma, hepatic cyst, intrahepatic bile duct stones and other benign liver lesions, helped to improve safety of surgery. Key words: Liver neoplasm; Laparoscopes; Indocyanine green; Fluorescence imaging; Hepatectomy

Robotic hepatectomy for benign and malignant liver tumors.

Minimally invasive hepatectomy for benign and malignant liver lesions has gained popularity in the past decade due to improved perioperative outcomes when compared to conventional 'open' technique. We aim to investigate our initial experience of robotic hepatectomy undertaken in our hepatobiliary program. All patients undergoing robotic hepatectomy between 2013 and 2018 were prospectively followed. Data are presented as median (mean ± SD). A total of 80 patients underwent robotic hepatectomy within the study period. 60% of the patients were women, age of 63 (62.4 ± 14.1), body mass index of 28 (29.6 ± 9.4), ASA class of 2.5 (2.5 ± 0.6), and MELD score of 7 (8.2 ± 2.8). Size of resected lesion was 3.9 (4.6 ± 3) cm. Indications for resection were metastatic lesions (30%), hepatocellular carcinoma (28%), cholangiocarcinoma (7%), gallbladder cancer (5%), neuroendocrine tumors (4%), and benign lesions (26%). Formal hepatectomy (right or left) was performed in 30% of the patients. Operative time was 233 (267.2 ± 109.6) minutes, and estimated blood loss was 150 (265.7 ± 319.9) ml. Length of hospital stay was 3 (5.0 ± 4.6) days. One patient was converted to 'open' approach. 10 patients experienced postoperative complications. Readmissions within 30 days of hospital discharge were seen in eight patients. Our data support that robotic hepatectomy is safe and feasible, with favorable short-term outcomes and low conversion rate. Robotic technology extends the application of minimally invasive techniques in the field of hepatobiliary surgery.

Comment on "Research on values of GDF-15 level in the diagnosis of primary liver cancer and evaluation of chemotherapeutic effect".

Objective To investigate the values of growth differentiation factor-15 (GDF-15) level in the diagnosis of primary liver cancer and evaluation of chemotherapeutic effect. Patients and methods 92 patients with liver cancer treated from June 2015 to May 2016 were selected as liver cancer group; 53 patients with benign liver lesion were selected as benign liver disease group, and 40 healthy subjects receiving physical examination were selected as healthy control group. Fasting venous blood was drawn from objects of study in the early morning at 1 d after admission and at the last day after chemotherapy (liver cancer group), and the serum GDF-15 level was measured. Results The serum GDF-15 levels in patients in liver cancer group and benign liver disease group were significantly higher than those in healthy control group and benign liver disease group (p 0.05). The ROC curve analysis showed that the threshold value of GDF-15 was 1573.23 ng/L, and the sensitivity, specificity, and accuracy were 81.23%, 83.99%, and 83.62%, respectively. The serum GDF-15 level in patients with progressive disease was significantly higher than those in patients with partial remission and stable disease, and the serum GDF-15 level in patients with stable disease was significantly higher than that in patients with partial remission (p Conclusions The serum GDF-15 level has certain clinical values in the diagnosis of primary liver cancer and evaluation of chemotherapeutic effect.

Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center

BackgroundDebate exists regarding outcomes of robot-assisted versus laparoscopic hepatectomy. We reviewed and analyzed major hepatectomies (resection of ≥3 Couinaud liver segments) performed in a minimally invasive fashion at a single institution. MethodsFrom 2011 to 2016, 473 major hepatectomy procedures were performed, of which 173 (37%) were performed in a minimally invasive fashion (57 robot-assisted and 116 laparoscopic). Patient demographics, operating statistics and outcomes were analyzed retrospectively. ResultsPatients undergoing robot-assisted versus laparoscopic hepatectomy were older (58.1 vs 53.2 years, respectively; p = 0.030), admitted to ICU postoperatively less frequently (43.9% vs 61.2%, respectively; p = 0.043), and readmitted less often within 90 days (7.0% vs 28.5%, respectively; p = 0.001). No significant differences were identified in relation to complications, blood loss, operative times, and length of stay. ConclusionRobot-assisted is an effective alternative to laparoscopic major hepatectomy for resection of malignant and benign liver lesions. Robotic-assisted offers technical advantages compared to laparoscopic surgery including improved optic visualization, operative dexterity, and ease of dissection and suturing. This experience suggested that the robotic platform was associated with improved outcomes including reduced postoperative ICU admission and 90-day readmission.

Predictive factors of malignancy in dogs with focal liver lesions using clinical data and ultrasonographic features

A definitive diagnosis of focal liver lesions (FLLs) requires invasive procedures for histopathologic examination. Thus, a simpler noninvasive diagnostic method, such as conventional ultrasonography combined with clinical data, is needed for the prediction of liver malignancy. The objective of this study was to examine the diagnostic accuracy of clinical data and ultrasonographic (US) features to differentiate benign and malignant liver lesions. Medical records and US images from dogs with FLLs that underwent abdominal US and histopathologic examinations following surgery or liver biopsy were retrospectively reviewed. Clinical data, including signalment, clinical signs and laboratory findings, and the US features of liver lesions that could act as predictive factors were assessed using univariate and multivariate analyses to evaluate the associations between predictive factors and liver malignancy. Based on the histopathologic results, 55 dogs with malignant lesions and 28 dogs with benign lesions were included in the study. The results of univariate analysis showed that several US features and platelet count were significantly associated with liver malignancy. Multivariate analysis revealed that the platelet count (thrombocytosis; odds ratio [OR]: 4.13, 95% confidence intervals [CI]: 1.81−9.41), lesion size (4.1 cm or greater; OR: 23.83, 95% CI: 3.74−151.95) and echotexture of FLLs (heterogenous; OR: 8.44; 95% CI: 1.37−51.91) were independent predictors for differentiating benign and malignant liver lesions, suggesting that a combination of clinical data and US findings of FLLs could predict liver malignancy in dogs.

Roles of contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging and their comparison in solid space-occupying lesions of the liver – Microbubbles and micromovements in imaging

Aims: This study aims to establish the role of contrast-enhanced ultrasound (CEUS) and diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of solid liver lesions. Settings and Design: An analysis of 22 patients undergoing CEUS and DW MRI following identification of 1 or more solid liver lesions on conventional ultrasonography. Subjects and Methods: The study is carried in a standard Doppler ultrasound machine with contrast ultrasound capabilities and 1.5T MRI machine over a period of 2 years from July 2015 to June 2017. After baseline US examination, a bolus of 1.0–2.4 ml of ultrasound contrast agent was administered intravenously followed by 10 ml of saline flush. CEUS images were obtained during arterial, portal venous, and delayed phases. After CEUS, patient is transferred to MRI scanning room where the DW imaging (DWI) sequence is taken. The CEUS and DW MRI diagnosis were compared to other imaging modalities, histopathology, and/or clinical follow-up after 12 months. Statistical Analysis Used: Sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate and receiver operating characteristic analysis curve was performed using Statistical Package – SPSS ver. 17.0. Statistical evaluation of qualitative analysis between benign and malignant lesions was performed using the Fisher's exact test. Results: CEUS correctly identified malignant liver lesions in 13 out of 14 cases, with the final diagnosis confirmed by histopathology in 6 cases, by other imaging modalities in 7 cases and follow-up in 1 case. Eight patients were correctly identified as benign liver lesions on CEUS imaging, with all these cases confirmed on other imaging modalities and/or follow-up and two cases by histopathology. In the detection of malignancy, the sensitivity is 86.7% and specificity is 100%. On the DW images the Mean apparent diffusion coefficient (ADC) value for benign lesions is 1.5 and mean ADC value for malignant lesions is 0.7. The ADC was significantly higher in benign lesions than in malignant lesions (P < 0.01). Conclusions: In our experience, CEUS and DWI with ADC values are highly accurate in confirming benign lesions, early detection of malignant lesions, and metastases in known primary malignancy patients. Other advantage of CEUS and DW MRI is that it is also cost-effective as compared to simultaneously performing individual investigations and can be performed in renal insufficiency patients. Hence, we conclude that CEUS and DW MRI sequence should be used in routine practice.

Robot-assisted enucleation of gigantic liver hemangiomas: Case series of 3 patients

IntroductionLiver hemangiomas are benign liver lesions that require surgical excision when large and symptomatic. Often, these tumors are removed through large anatomical resections which sacrifice more liver parenchyma than needed. Tumor enucleation, which takes advantage of a digitoclasia-like technique along the plane between the tumor pseudo-capsule and liver parenchyma, poses challenges when performed laparoscopically. We propose a parenchymal sparing, minimally invasive, robotic-assisted technique to remove liver hemangiomas. Presentation of casesThree male patients with symptomatic hemangiomas were treated in our center between 2015 and 2018. The lesions were located in segment II, III and segment IV-V respectively. Robotic-assisted hemangioma enucleation was accomplished successfully in all three patients. The procedures were performed with a parenchyma-sparing intent and a formal segmentectomy was not required. There were no conversions to open surgery. DiscussionThe robotic platform provides a powerful tool in the enucleation of liver hemangiomas. The enhanced vision and the superior suturing ability allow to develop safely the plane between the tumor pseudo-capsule and the liver parenchyma, with outstanding selective control of all the vascular supply and drainage encountered during the dissection. Furthermore, precision of the hilar dissection allows selective lobar or sectorial arterial control which helps minimize intraoperative bleeding. ConclusionIn our experience, robot-assisted enucleation of liver hemangiomas offers low morbidity, fast recovery, excellent cosmetic results, and it could become a therapeutic option when the location of the hemangioma allows this approach.

CEUS in paediatric hepatic lesions

Focal liver lesions (FLL) are commonly observed in adult patients and rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions in childhood are lacking. Primary hepatic tumors are a diverse group of epithelial and mesenchymal tumors accounting for 0.5 and 2.0% of all pediatric neoplasms. Focal liver lesions in children can be benign, malignant, or indeterminate. About one-third of the pediatric primary liver masses are benign. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. The presentation will focus on the most frequently encountered benign and malignant liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma, hepatocellular carcinoma and metastases) .

Choosing Wisely Canada-Top Five List in Hepatology: Official Position Statement of the Canadian Association for the Study of the Liver (CASL) and Choosing Wisely Canada (CWC)

Introduction and aim. The prevalence and incidence of chronic liver disease is increasing resulting, in substantial direct and indirect medical costs. Overuse of investigations, treatments and procedures contribute to rising health care costs and can expose patients to unnecessary harm and delay in receiving care. The Choosing Wisely Canada (CWC) campaign has encouraged professional societies to develop statements that are directly actionable by their members in an effort to promote higher-value health care that will lead to downstream effect on how other practitioners make decisions.Material and methods. The Canadian Association for the Study of the Liver (CASL) established its Choosing Wisely top five list of recommendations using the framework put forward by CWC. CASL convened a task force that developed a list of draft recommendations and shared this with CASL membership electronically with eventual ranking of the top five recommendations by consensus at Canadian Digestives Disease Week (CDDW) 2017. Following revisions, the CASL Executive Committee endorsed the final list, which was disseminated online by CWC (July 2017).Results. The top five recommendations physicians and patients should question include: 1) Don’t order serum ammonia to diagnose or manage hepatic encephalopathy (HE). 2) Don’t routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures. 3) Don’t order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis. 4) Don’t perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions. 5) Don’t repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of anti-viral treatment.Conclusion. The Choosing Wisely recommendations will foster patient-physician discussions, reduce unnecessary treatment and testing, avert adverse effects from testing and treatment along with reducing medical expenditure in hepatology.

The application value of LI-RADS classification of contrast enhanced ultrasound in the diagnosis of hepatocellular carcinoma

Objective To explore the clinical value of the Liver Imaging Report and Data System (LI-RADS) with contrast enhanced ultrasound(CEUS) in the diagnosis of hepatocellular carcinoma (HCC). Methods From October 2012 to July 2018, the CEUS data of patients at high risk for HCC were retrospectively analyzed. A total of 197 lesions in 178 patients were classified with reference to the 2017 version of CEUS LI-RADS classification standard. Diagnostic reference standard was surgical pathology. The relationship between the LI-RADS classification and the pathological diagnosis was evaluated. Results One hundred and ninety-seven lesions, with an average size of (2.9±1.6)cm, were pathologically confirmed to be 170 HCC (86.3%), 17 non-HCC malignant lesions (8.6%), and 10 liver benign lesions (5.1%). There were 6 (3.0%), 37(18.8%), 134 (68.0%) and 20 (10.2%) lesions classified into LR-3, LR-4, LR-5 and LR-M category, respectively. Positive predictive values of HCC in LR-3, LR-4 and LR-5 category were 16.7% (1/6), 89.2% (33/37), 97.0% (130/134), respectively. LR-5 category had high positive predictive value of HCC(97.0%), but low sensitivity (76.5%). If LR-5 category combined with LR-4 category were diagnosed as HCC, the diagnostic accuracy was significantly higher than that of LR-5 category (92.4% vs 77.7%), and the difference was statistically significant (P<0.05). 95.0% (19/20) lesions of LR-M category were malignant, of which 30.0%(6/20) lesions were HCC. 76.9%(10/13) of intrathecal cholangiocarcinoma was characterized by LR-M. Conclusions The LI-RADS classification of CEUS has high application value for diagnosis and differentiation of HCC. Key words: Contrast enhanced ultrasound; Hepatocellular carcinoma; Liver imaging report and data system

Ciliated hepatic foregut cyst, about a case and review of imaging features

Ciliated hepatic foregut cyst is a rare benign liver lesion with about a hundred cases described in the literature.

Contrast-Enhanced Ultrasound of Benign Focal LiverLesions.

The diagnostic handling of benign focal liver lesions (FLLs) is a challenge and it is difficult to avoid over- and underdiagnosis. Conventional B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are the first-line imaging methods to detect and characterize FLLs. This CME article discusses the diagnostic workup of benign liver tumors.

Precision and reliability of liver iodine quantification from spectral detector CT: evidence from phantom and patient data

To comprehensively assess precision, reproducibility, and repeatability of iodine maps from spectral detector CT (SDCT) in a phantom and in patients with repetitive examination of the abdomen. Seventy-seven patients who underwent examination two (n = 52) or three (n = 25) times according to clinical indications were included in this IRB-approved, retrospective study. The anthropomorphic liver phantom and all patients were scanned with a standardized protocol (SSDE in patients 15.8mGy). In patients, i.v. contrast was administered and portal venous images were acquired using bolus-tracking technique. The phantom was scanned three times at three time points; in one acquisition, image reconstruction was repeated three times. Region of interest (ROI) were placed automatically (phantom) or manually (patients) in the liver parenchyma (mimic) and the portal vein; attenuation in conventional images (CI [HU]) and iodine map concentrations (IM [mg/ml]) were recorded. The coefficient of variation (CV [%]) was used to compare between repetitive acquisitions. If present, additional ROI were placed in cysts (n = 29) and hemangioma (n = 29). Differences throughout all phantom examinations were < 2%. In patients, differences between two examinations were higher (CV for CI/IM: portal vein, 2.5%/3.2%; liver parenchyma, -0.5%/-3.0% for CI/IM). In 80% of patients, these differences were within a ± 20% limit. Differences in benign liver lesions were even higher (68% and 38%, for CI and IM, respectively). Iodine maps from SDCT allow for reliable quantification of iodine content in phantoms; while in patients, rather large differences between repetitive examinations are likely due to differences in biological distribution. This underlines the need for careful clinical interpretation and further protocol optimization. • Spectral detector computed tomography allows for reliable quantification of iodine in phantoms. • In patients, the offset between repetitive examinations varies by 20%, likely due to differences in biological distribution. • Clinically, iodine maps should be interpreted with caution and should take the intra-individual variability of iodine distribution over time into account.

Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: Comparison of postoperative outcomes and long-term survivals using propensity score matching analysis

BackgroundMinimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation. MethodsClinicopathological data of patients who underwent liver resection for HCC between 2005 and 2016 were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing conventional open hepatectomy (OH) after 1:1 propensity score matching. ResultsDuring the study period, 407 patients underwent liver resection for HCC with curative intent. Fifty-six patients underwent MIH and were compared with a matched cohort of 56 patients who underwent OH. The rate of patients with fibrosis/cirrhosis (82% vs. 86%, p = 0.959), multiple lesions (32% vs. 32%, p = 1.00), tumor size >30 mm (61% vs. 55%, p = 0.566), and major resection (16% vs. 16%, p = 1.00) was comparable between the two groups (MIH vs. OH). MIH was associated with lower 90-day complication rate (32% vs. 54%, p = 0.022), lower postoperative major complication rate (14% vs. 30%, p = 0.041), lower liver failure rate (0% vs. 7%, p = 0.042), lower 90-day mortality rate (0 vs. 7%, p = 0.042), and shorter length of hospital stay (9 vs. 12 days, p = 0.009) compared to OH. After a median follow-up time of 51 months, MIH and OH showed comparable 5-year overall survival (54% vs. 41%, p = 0.151), and 5-year disease-free survival rates (50% vs. 38%, p = 0.956). ConclusionsMIH for HCC is associated with lower postoperative morbidity and mortality and shorter length of hospital stay, resulting in oncologic outcomes similar to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable HCC.

Laparoscopic hepatectomy for benign hepatic lesions: short and long-term outcomes including quality-of-life evaluation

Aim: Even though laparoscopic hepatectomy (LH) has proved to be both safe and effective in specialized centers; the restricted indications for resection in the case of benign liver lesions has resulted in poorly reported outcomes. Our aim was to describe the short and long-term results of LH to treat benign hepatic lesions, including quality of life (QoL) evaluation.

Subclassification of hepatocellular adenomas: practical considerations in the implementation of the Bordeaux criteria

Hepatocellular adenomas are benign liver lesions with a risk of rupture and malignant transformation. Various molecular subgroups have been identified which appear to have characteristic morphological and immunohistochemical features. We examined the morphology and immunohistochemical profile of a series of 121 HCA from 97 patients to identify the HCA subtypes present and determine the number at risk for malignant transformation according to the World Health Organization (WHO) criteria for hepatocellular adenomas. There were 34 HNF1α inactivated HCA (28%), 61 inflammatory HCA (50%), 15 β-catenin activated HCA (12%) and 11 unclassified adenomas (9%). This proportion of cases was similar to that seen in other series utilising molecular classification. The morphological features of the adenomas were suggestive but not definite indicators of the subtypes present. Morphological features that showed overlap between the subtypes included steatosis within the lesion, a ductular reaction and focal atypia, so that immunohistochemical typing was required for accurate classification. In conclusion, immunohistochemistry is a clinically useful surrogate for identifying underlying molecular changes in the HCA subtypes.

Non-contrast liver MRI as an alternative to gadoxetic acid-enhanced MRI for liver metastasis from colorectal cancer.

Liver magnetic resonance imaging (MRI) provides reliable diagnostic performance for detecting liver metastasis but is costly and time-consuming. To compare the diagnostic performance of non-contrast liver MRI to whole MRI using gadoxetic acid for detecting liver metastasis in patients with colorectal cancer (CRC). We included 175 patients with histologically confirmed 401 liver metastases and 73 benign liver lesions. A non-contrast MRI (T1-weighted, T2-weighted, and diffusion-weighted images) with or without multidetector computed tomography (MDCT) and a whole MRI (gadoxetic acid-enhanced and non-contrast MRI) were analyzed independently by two observers to detect liver metastasis using receiver operating characteristic analysis. We found no significant differences in Az value (range = 0.914-0.997), sensitivity (range = 95.2-99.6%), specificity (range = 77.3-100%), or positive (range = 92.9-100%) or negative predictive value (range = 87.5-95.7%) between the non-contrast MRI with or without MDCT and the whole MRI for both observers for all lesions as well as lesions ≤1.0 cm and lesions >1.0 cm in size ( P = 0.203-1.000). Combined MDCT and non-contrast MRI led to similar numbers of false-positive diagnosis to the whole MRI (eight for Observers 1 and 4 vs. 3 for Observer 2). Non-contrast liver MRI may serve as an alternative to gadoxetic acid-enhanced MRI for detecting and characterizing liver metastasis from CRC, at least in patients with relatively high risk of liver metastasis who underwent MDCT. Non-contrast liver MRI could be beneficial especially for patients with lesions that are already documented as benign but require additional follow-up MRIs.