Diagnosis and Follow-up of Incidental Liver Lesions in Children

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Boaz Karmazyn ◽  
Girish S. Rao ◽  
Lindsey S. Johnstone ◽  
Tyler S. Severance ◽  
Michael J. Ferguson ◽  
...  
Keyword(s):  
Liver Lesions

scholarly journals Evaluation of Contrast-Enhanced Intraoperative Ultrasound in the Detection and Management of Liver Lesions in Patients with Hepatocellular Carcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Cristina Pace ◽  
Vittorio Nardone ◽  
Silvia Roma ◽  
Fabrizio Chegai ◽  
Luca Toti ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Intraoperative Ultrasound ◽  
Preoperative Imaging ◽  
Liver Lesions ◽  
Therapy Decision ◽  
Contrast Enhanced ◽  
Regenerative Nodules ◽  
Malignant Liver

Aim. To evaluate the role of contrast-enhanced intraoperative ultrasound (CE-IOUS) during liver surgery in the detection and management of liver lesions in patients with hepatocellular carcinoma (HCC). Materials and Methods. From December 2016 to December 2017, 50 patients with HCC, who were candidates for liver resection, were evaluated with intraoperative ultrasound (IOUS). For all patients, MRI and/or CT were performed before surgery. During surgery, IOUS was performed after liver mobilization, and when nodules that had not been detected in the preoperative MRI and/or CT were observed, CE-IOUS scans were carried out with the dual purpose of better characterizing the unknown lesion and discovering new lesions. Results. In 12 patients, IOUS showed 14 nodules not detected by preoperative MRI and/or CT, before surgery. Out of the 12 lesions, five presented vascular features compatible with those of malignant HCC to the evaluation with CE-IOUS and four of these were simultaneously treated with intraoperative radiofrequency ablation (RFA). The fifth lesion was resected by the surgeon. The remaining nine lesions recognized by IOUS were evaluated as benign at CE-IOUS and considered regenerative nodules. The last diagnosis was confirmed during follow-up obtained by means of CT and/or MRI after 1, 3, 6, or 12 months. Conclusion. In our experience, CE-IOUS is a useful diagnostic tool in both benign pathologies, such as regenerative nodules, and malignant liver lesions. The advantage of this approach is the possibility of intraoperatively characterizing, based on vascularization patterns, lesions that could not be diagnosed by preoperative imaging, resulting in modification of the surgical therapy decision and expansion of the resection or intraoperative ablation.

scholarly journals Appearance of Focal Nodular Hyperplasia after Chemotherapy in Two Patients during Follow-Up of Colon Carcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
L. A. de Wert ◽  
S. A. Huisman ◽  
F. Imani ◽  
D. J. de Gooyer ◽  
J. M. G. H. van Riel ◽  
...  
Keyword(s):  
Colon Carcinoma ◽  
Metastatic Disease ◽  
Focal Nodular Hyperplasia ◽  
Liver Parenchyma ◽  
Liver Lesions ◽  
First Case ◽  
Nodular Hyperplasia ◽  
Magnetic Resonance Imaging Mri ◽  
Induced Changes

Surgical liver resection is a treatment option in patients with resectable colorectal liver metastases. We present two cases of focal nodular hyperplasia (FNH) development after treatment with oxaliplatin during follow-up of colon carcinoma. The first case was a 40-year-old male patient who developed multiple liver lesions suspect for metastatic disease four years after he had undergone laparoscopic right-sided hemicolectomy and adjuvant chemotherapy (capecitabine and oxaliplatin). He underwent a metastasectomy of segments three and four and microwave ablation (MWA) of the lesion in segment one. Pathological analysis demonstrated FNH. The second patient was a 21-year-old woman who presented with multiple liver lesions during follow-up for colon carcinoma. She underwent a laparoscopic right-sided hemicolectomy and was adjuvantly treated with capecitabine and oxaliplatin three years ago. Magnetic resonance imaging (MRI) was performed, and the lesions showed no signs of metastatic disease but were classified as FNH. Therefore, the decision was made to follow up the patient. In conclusion, the development of benign liver lesions could occur during follow-up of colon carcinoma and might be caused by oxaliplatin-induced changes to the liver parenchyma. Hence, it is important to distinguish these from metastatic liver disease.

scholarly journals The Fate of Indeterminate Liver Lesions: What Proportion Are Precursors of Hepatocellular Carcinoma? A Retrospective Follow-up Study

2021 ◽  
Author(s):  
Sara Cococcia ◽  
Priti Dutta ◽  
Melika Moghim ◽  
Brian Hogan ◽  
Sudeep Tanwar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Platelet Count ◽  
Proportional Hazards ◽  
High Serum ◽  
Cox Proportional Hazards ◽  
Liver Lesions ◽  
Electronic Patient Records ◽  
Follow Up Study ◽  
Low Platelet Count

Abstract BackgroundThe natural history and incidence of hepatocellular carcinoma (HCC) arising from indeterminate liver lesions is not well characterised. We aimed to define the incidence of HCC in a cohort of patients undergoing surveillance by magnetic resonance imaging (MRI) and estimate any associations with incident HCC.MethodsWe performed a retrospective follow-up study, identifying MRI scans in which indeterminate lesions had been reported between January 2006 and January 2017. Subsequent MRI scan reports were reviewed for incident HCC arising from indeterminate lesions, data were extracted from electronic patient records and survival analysis performed to estimate associations with baseline factors.ResultsOne hundred and nine patients with indeterminate lesions on MRI were identified. HCC developed in 19 (17%) patients over mean follow up of 4.6 years. Univariate Cox proportional hazards analysis found incident HCC to be significantly associated with baseline low platelet count (hazard ratio (HR) = 7.3 (95% confidence intervals (CI); 2.1 – 24.9), high serum alpha-fetoprotein level (HR = 2.7 (95% CI; 1.0 – 7.1)) and alcohol consumption above fourteen units weekly (HR = 3.1 (95% CI; 1.1 – 8.7)). Multivariate analysis, however, found that only low platelet count was independently associated with HCC (HR = 5.5 (95% CI; 0.6 – 5.1)).ConclusionsHCC arises in approximately one fifth of indeterminate liver lesions over 4.6 years and is associated with a low platelet count at the time of first diagnosis of an indeterminate lesion. Our data support a strategy of enhanced surveillance in patients with indeterminate lesions.

scholarly journals Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1056
Author(s):  
Dimitrios K. Filippiadis ◽  
Georgios Velonakis ◽  
Argyro Mazioti ◽  
Athanasios Tsochatzis ◽  
Thomas Vrachliotis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Local Anesthesia ◽  
Microwave Ablation ◽  
Liver Lesions ◽  
Technical Success ◽  
Hepatic Dome ◽  
Malignant Liver ◽  
Tumor Remnant ◽  
Malignant Liver Lesions

Background and Objectives: The aim of the present study was to report the safety and efficacy of percutaneous navigation under local anesthesia for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Patients with primary and secondary malignant liver lesions located in the hepatic dome who underwent percutaneous computed tomography-guided microwave ablation using a computer-assisted navigation system under local anesthesia were prospectively evaluated. The primary objective was technical success. Materials and Methods: The sample consisted of 10 participants (16 lesions) with a mean age of 60.60 years (SD = 9.25 years) and a mean size of 20.37 ± 7.29 cm, and the mean follow-up time was 3.4 months (SD = 1.41) months. Results: Primary technical success was 93.75%. Tumor remnant was noticed at one month follow-up in a single metastatic lesion, which was re-treated with an ablation session, and no tumor remnant was depicted in the subsequent imaging follow-up (secondary technical success 100%). Grade I self-limited complications (according to the CIRSE classification system) included small pleural effusion (n = 1) and minor bleeding post antenna removal (n = 1) requiring nothing but observation. Conclusions: the findings of the present study indicate that percutaneous navigation under local anesthesia is a safe and efficacious approach for computed tomography-guided microwave ablation of malignant liver lesions located in the hepatic dome. Large randomized controlled studies are warranted to observe treatment effectiveness and compare the results with those of other options.

Robotic-assisted surgery for rectal cancer − results of a non-randomized study

2021 ◽  
Vol 100 (5) ◽  
Keyword(s):  
Rectal Cancer ◽  
Tnm Classification ◽  
Randomized Study ◽  
Radical Resection ◽  
Liver Lesions ◽  
Mesorectal Excision ◽  
Robotic Assisted ◽  
The Third ◽  
Robotic Assisted Surgery

Introduction: The Czech Republic belongs to countries in which colorectal cancer significantly contributes to the overall oncological burden. Radical removal of tumor-affected tissues plays a key role in the multimodal therapy of rectal cancer. In the first decade of the third millennium the mini-invasive approach in rectal cancer surgery gradually expanded to include robotic-assisted surgeries. The aim of this paper is to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Methods: 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 01 Jan 2016 and 31 Dec 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analyzed − gender, age, body mass index (BMI), ASA (American Society of Anesthesiologist) classification, stage of cancer according to TNM classification (UICC), tumor location, neoadjuvant chemoradiotherapy, operative time, blood loss, anastomotic leaks, surgical complications, 30-day mortality, local and metastatic recurrence and the length of follow-up. The data were analyzed using methods of descriptive statistics. Results: 204 patients with rectal cancer (RC) of whom 138 were men and 66 were women underwent robotic surgery at our department during the five years period. In 97 (47.5%) cases the disease was diagnosed in an advanced stage (stages III and IV of the TNM classification). Eighteen patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the diagnosis. Liver first approach was indicated in 8 (44.4%) patients; two patients underwent radical resection of liver lesions with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease; partial mesorectal excision was performed in 68 cases. Eighteen complications were documented in the entire group. Clinically relevant anastomotic leak with the need of therapy occurred in 5 (3.6%) cases. Surgical therapy was needed in more than half of the cases (61.1%). One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Recurrence of secondary liver disease or metachronous liver lesions occurred in 17 patients, most (76.5%) underwent liver resection with curative intent. The median follow-up period was 20 months. Conclusion: Surgical therapy is the only potentially curative therapy for rectal cancer (RC). Robotic-assisted surgery has become a routine therapeutic modality for RC worldwide during the first two decades of the third millennium. Da Vinci assisted surgeries dominate at the authors’ center in the surgical treatment of RC. Compared to open and laparoscopic resections of RC, robotic-assisted operations achieve the same clinical and oncological results with a lower frequency of complications.

Role of ultrasound contrast agent in a tertiary cancer center: Experience in 75 patients with liver biopsy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14671-e14671
Author(s):  
Amir Ata Rahnemai-Azar ◽  
Elias Kikano ◽  
Daniel Arnold Smith ◽  
Nikhil H. Ramaiya ◽  
Nami R Azar
Keyword(s):  
Renal Failure ◽  
Liver Biopsy ◽  
Contrast Agent ◽  
Cancer Patients ◽  
Liver Tumors ◽  
Ultrasound Contrast Agent ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Negative Biopsy

e14671 Background: The sensitivity of B-mode ultrasound (US) in detecting hepatic lesions has been reported to be between 55-85%. A recently FDA approved US contrast agent has been shown to increase the detectability of liver lesions; yet, there is paucity of knowledge regarding its application in US guided biopsies. The aim of this study was to determine accuracy and applicability of contrast enhanced US (CEUS) guided biopsies of liver lesions in cancer patients. Methods: A prospective registry of 75 patients (M = 54%, F = 46%, Age: 63y±14), that underwent CEUS guided liver biopsy in 2017-2018, were retrospectively reviewed. The decision to apply US contrast was made based on pre-procedural and intra-procedural clinical findings. Lesions with negative biopsy results were reviewed in follow up imaging to determine any evidence of potential positive malignancy. Results: History of renal failure that precluded application of iodinated IV contrast was the main pre-procedural indication (17%). Intra-procedural indications included: poor visualization of lesions in B-mode US (78%), targeting enhancing part of lesions (necrotic, post ablation or cystic) (16%), and lesion selection (6%). Diameter of the lesions were ≤ 20mm in 46% of patients. Biopsy results were positive in 50 patients, and included 32% primary liver tumors (hepatocellular carcinoma and cholangiocarcinoma) and 68% metastasis (pancreas: 24%, breast: 12%, GI tract: 10%, lung: 8% and other: 14%). Of the 25 patients with negative biopsy results, 6 did not have follow up imaging and 3 were later found to have positive malignancy (Negative predictive value: 84%, accuracy: 96%). Genomic sequencing was established in 34% of the patients. Based on the biopsy/genomics results, patients underwent systemic treatment (56%), locoregional treatment (16%), combination (6%) or surgery (2%). 10% of patients selected hospice care and 10% lost follow up. Conclusions: CEUS increases the accuracy of US guided biopsies of focal liver lesions, by improving visualization, targeting viable parts and also in patients with renal failure, or small lesions. Findings from these biopsies could improve management of cancer patients by categorizing them into different treatment groups.

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