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Incidental liver lesions create uncertainty, anxiety

Four experts will help clinicians take the uncertainty out of the diagnosis and management of incidental liver lesions during Monday’s DDW® Clinical Symposium, Incidental Liver Findings: When to Treat, How to Follow. The 90-minute symposium, which is co-sponsored by AASLD, AGA and SSAT will feature insights from experts in radiology, hepatology and surgery.

“During the course of any kind of imaging study — whether it’s CT, ultrasound or MRI — we often find focal liver lesions,” said symposium co-chair Jean-Nicolas Vauthey, MD, professor of surgical oncology at the University of Texas MD Anderson Cancer Center, Houston. “We don’t always know what they are, and it creates a great deal of anxiety. Is this a cancer? Is it going to grow?”

While most of these lesions turn out to be benign, such as hepatic hemangioma or focal nodular hyperplasia, the physician must carefully rule out more serious possibilities. Dr. Vauthey said imaging is a valuable tool when evaluating incidental liver findings.

“Imaging can lead to a diagnosis for almost all of these patients,” he said. “A couple of decades ago, we would have done a biopsy or even removed the mass. Now, with MRI and other modern imaging techniques, we can usually define these lesions without surgery.”

Bachir Taouli, MD, associate professor of radiology and medicine at Icahn School of Medicine at Mount Sinai, New York, will provide the radiologist’s perspective and review the role of imaging when diagnosing liver lesions.

In some instances, surgery may still be appropriate, Dr. Vauthey noted. For example, a combination of imaging and biopsy may be needed to differentiate between the multiple types of adenomas, he said.

“We now have a combination of histopathological markers that define the small subset of adenomas that may need surgical attention,” Dr. Vauthey explained. “There are four types of adenoma and each has its own set of risks. These tumors will probably draw the most attention from attendees because there are several types with varying risks of cancer, rupture and bleeding. Accurately identifying the correct type is necessary to understand the potential risk for the patient.”

Also during the symposium, Norman L. Sussman, MD, associate professor of surgery in the division of abdominal transplantation at Baylor College of Medicine, Houston, will discuss incidental liver findings from a hepatologist’s perspective.

“Dr. Sussman will review the biomarkers you may want to consider when trying to rule out cancer,” Dr. Vauthey said. “He’ll also discuss other risk factors, such as hepatitis B or C, that can trigger malignancy.”

Yun Shin Chun, MD, FACS, assistant professor of surgical oncology at MD Anderson Cancer Center, will discuss surgical intervention when diagnosing and treating liver incidentalomas.

“The surgeon is rarely needed beyond consultation,” Dr. Vauthey said. “However, there are those instances where surgery is needed. Another example is the small subset of patients with hepatic hemangioma who will need to be addressed surgically. But for the most part — rather than biopsy — we monitor patients to assess the evolution of the incidentaloma.”

To put all the information into context, the symposium will end with several case presentations from Sean P. Cleary, MD, professor of surgery at the Mayo Clinic, Rochester, MN.

This session will take place on Monday, May 8, from 10-11:30 a.m. in Room S103. Please refer to the DDW Mobile App
or the Program section of Monday’s DDW Daily News for additional information on this and other DDW sessions.

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