PTU-021Do all regenerative nodules become hepatocellular carcinoma? The outcome of 4years MRI surveillance

• Published in: Gut Vol. 61; no. Suppl 2; p. A192
• Main Authors: Hogan, B, Trembling, P M, Tanwar, S, Yu, D, O'Beirne, J P, Rosenberg, W M
• Format: Journal Article
• Language: English
• Published: 01.07.2012
• Subjects: Hepatitis B virus; Hepatitis C virus
• ISSN: 0017-5749
• DOI: 10.1136/gutjnl-2012-302514c.21

IntroductionThere are few epidemiological data on the longitudinal follow-up of nodular lesions in cirrhotic patients.MethodsThe Royal Free Hospital database was searched for all reports of MRI scans of the liver in which the term "nodule" was used. 630 such scans were identified in 369 individual patients between 1 January 2006 and 1 January 2011. Patients were then excluded if there was <1-year follow-up (45), if hepatocellular carcinoma (HCC) was identified on the initial scan (135), if an alternative diagnosis was made (129) or if no significant arterialised lesion was reported despite previous suspicion on ultrasound scanning (31). Retrospective analysis was, therefore, performed on 29 cirrhotic patients with a diagnosis of regenerative, indeterminate or dysplastic arterialised nodules at baseline and >1year total follow-up with MRI and alpha-fetoprotein (AFP) surveillance.ResultsThe median age at first scan was 55years (range 36-73) and the most common aetiologies of cirrhosis were hepatitis C (55%), hepatitis B (10%) and alcohol (25%) with 10% other. The median follow-up period was 22months (12-56) and the median number of scans 4 (2-10). At baseline nodules were described as indeterminate in 48%, regenerative in 45% and dysplastic in 7%. The prevalence of HCC after 1, 2, 3 and 4years of follow-up was 5 (17%), 9 (31%), 11 (38%) and 11 (38%) respectively, with the highest incidence occurring in the first 2years of follow-up (82% of cases). The median size of nodule at baseline in those who developed HCC was 10mm (5-18) and it was 9mm (5-26) in those who did not. There was no association between the description of the nodule and the likelihood of developing HCC (five arising from indeterminate and 6 from regenerative nodules) and the two nodules initially described as dysplastic did not transform to tumour. AFP results were not informative.Conclusion31% of lesions described as arterialised nodules when first scanned developed into HCC within 2years and initial radiological features consistent with "regenerative" nodules are not reassuring. Patients with discrete arterialised nodules should be enrolled in enhanced surveillance programmes.Competing interestsNone declared.