Liver Masses: A Clinical, Radiologic, and Pathologic Perspective

Sudhakar K. Venkatesh; Vishal Chandan; Lewis R. Roberts

Clin Gastroenterol Hepatol. 2014;12(9):1414-1429.

Surveillance for Hepatocellular Carcinoma

For individuals with chronic hepatitis B virus (HBV) infection or cirrhosis from any cause who are at risk for development of HCC, surveillance ultrasonography every 6 months is recommended for early identification of HCCs and is critical for achieving long-term survival (Table 2).^[2]

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Table 1. Clinical Classification of Liver Mass Lesions
Benign mass lesions for which no treatment is needed
Hepatic hemangioma
FNH
Benign liver cyst
Focal fat or focal fat sparing
Benign mass lesions for which treatment or follow-up evaluation is required
Hepatic adenoma and adenomatosis
Biliary cystadenoma
Hepatic abscess
Echinococcal cysts
Granulomatous Inflammation
Inflammatory pseudotumor of the liver
Malignant mass lesions for which treatment is required if feasible
HCC
Cholangiocarcinoma
Liver metastases from other primary sites
Biliary cystadenocarcinoma
Hepatic angiosarcoma
Lymphoma

Table 2. Recommended High-Risk Population for Screening for HCC
Patients with chronic HBV infection (hepatitis B surface antigen positivity)
Asian men older than age 40
Asian women older than age 50
Africans older than age 20
Patients with a family history of HCC
Patients with high HBV viral loads
Patients with evidence of active hepatitis
Patients with cirrhosis of any cause
Chronic hepatitis B
Chronic hepatitis C
Alcoholic cirrhosis
Nonalcoholic steatohepatitis
Hereditary hemochromatosis
Autoimmune hepatitis
Primary biliary cirrhosis
α-1 antitrypsin deficiency