Liver mass evaluation

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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 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 algorithm below summarizes the evaluation of solitary liver mass with history of cirrhosis or chronic HBV infection:

Solitary liver mass with a history of cirrhosis or HBV infection

<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 a history of cirrhosis or HBV infection

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