Outcome of liver lesions indeterminate for malignancy on ultrasound: the role of patient age, risk status, and lesion echogenicity

  • Amelia M. Wnorowski
  • Tessa S. Cook
  • Darco Lalevic
  • Jill E. Langer
  • Hanna M. Zafar
Article
  • 17 Downloads

Abstract

Purpose

The purpose of this study was to evaluate the relationship between final outcome of lesions indeterminate for malignancy on ultrasound (US) and patient and imaging characteristics.

Methods

We identified all patients with indeterminate liver lesions on US between 9/1/2013 and 12/31/2014 using institutional codes based on radiologist opinion. Miscoded lesions (n = 30) and patients with no imaging, pathology, or clinical follow-up at our health system (n = 6) were excluded. Final diagnostic category of malignant, benign, pseudolesion, or indeterminate was assigned using imaging, pathology, and clinical follow-up. Differences in diagnostic categories were compared by patient (age, gender, race, known malignancy. or liver disease) and imaging characteristics (lesion size, echogenicity. and number). Independent likelihood of a benign final diagnostic category was adjusted for significant variables on univariate analysis.

Results

Indeterminate liver lesions on US were found in 153/6813 patients (2%). Final diagnostic categories were malignant (11/153, 7%), benign (94/153, 61%), pseudolesion (42/153, 27%). and indeterminate (6/153, 4%). Nearly one-third of hypoechoic masses in patients with known malignancy or liver disease (i.e., high-risk status) ≥ 46 years of age were malignant (9/28, 32%). On multivariate analysis, patients of age ≥ 61 years and high-risk status were associated with decreased likelihood of benign diagnostic category (OR .19 (95% CI .07–.51) and OR .40 (95% CI .18–.88), p values .001 and .022, respectively).

Conclusions

2% of patients undergoing abdominal US have sonographically indeterminate liver lesions, of which 7% are malignant. Older, high-risk patients with hypoechoic lesions should receive short-term follow-up as one-third will have malignant lesions. Younger, low-risk patients should receive conservative follow-up, regardless of US imaging features.

Keywords

Liver neoplasm Indeterminate liver lesion Liver ultrasound Focal liver lesions 

Notes

Compliance with ethical standards

Funding

No funding was received for the performance of this study.

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Requirement for informed consent was waived by our Institutional Review Board for this retrospective study.

Supplementary material

261_2018_1571_MOESM1_ESM.pdf (124 kb)
Supplementary material 1 (PDF 123 kb)

References

  1. 1.
    Hanbidge AE, Buckler PM, O’Malley ME, Wilson SR (2004) From the RSNA refresher courses: imaging evaluation for acute pain in the right upper quadrant. Radiographics 24:1117–1135CrossRefPubMedGoogle Scholar
  2. 2.
    Tchelepi H, Ralls PW, Radin R, Grant E (2002) Sonography of diffuse liver disease. J Ultrasound Med 21:1023–1032; quiz 1033–4CrossRefPubMedGoogle Scholar
  3. 3.
    Kaltenbach TE, Engler P, Kratzer W, et al. (2016) Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol 41:25–32CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Zafar HM, Chadalavada SC, Kahn CE Jr, et al. (2015) Code abdomen: an assessment coding scheme for abdominal imaging findings possibly representing cancer. J Am Coll Radiol 12:947–950CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    American College of Radiology. Liver imaging reporting and data system. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS. Accessed 7 March 2018
  6. 6.
    Choudhary MM, Gupta A, Bena J, Emch T, Singh AD (2016) Hepatic ultrasonography for surveillance in patients with uveal melanoma. JAMA Ophthalmol 134:174–180CrossRefPubMedGoogle Scholar
  7. 7.
    Beal EW, Albert S, McNally M, et al. (2014) An indeterminate nodule in the cirrhotic liver discovered by surveillance imaging is a prelude to malignancy. J Surg Oncol 110:967–969CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Khalili K, Kim TK, Jang HJ, et al. (2011) Indeterminate 1-2-cm nodules found on hepatocellular carcinoma surveillance: biopsy for all, some, or none? Hepatology 54:2048–2054CrossRefPubMedGoogle Scholar
  9. 9.
    Tanabe M, Kanki A, Wolfson T, et al. (2016) Imaging outcomes of liver imaging reporting and data system version 2014 category 2, 3, and 4 observations detected at CT and MR imaging. Radiology 281:129–139CrossRefPubMedGoogle Scholar
  10. 10.
    Leifer DM, Middleton WD, Teefey SA, Menias CO, Leahy JR (2000) Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology 214:167–172CrossRefPubMedGoogle Scholar
  11. 11.
    Bruix J, Sherman M (2011) American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    D’Onofrio M, Crosara S, De Robertis R, Canestrini S, Mucelli RP (2015) Contrast-enhanced ultrasound of focal liver lesions. AJR Am J Roentgenol 205:W56–W66CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amelia M. Wnorowski
    • 1
  • Tessa S. Cook
    • 2
  • Darco Lalevic
    • 2
  • Jill E. Langer
    • 2
  • Hanna M. Zafar
    • 2
  1. 1.University of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations