Hepatic incidentaloma: the rule of tens.

OBJECTIVES: Hepatic incidentalomas (HI) are asymptomatic lesions detected incidentally during investigations for other pathologies. This prospective series outlines the management and outcomes of 121 HI managed over 7 years.
METHODS: Data were recorded prospectively on 121 patients referred between 2003 and 2010 for assessment of HI out of 1081 patients referred for a hepatic resection. Patients were reviewed in multidisciplinary meetings and investigated with tumour markers and radiological investigations. HI were classified as hypo- or hypervascular depending on arterial phase CT scan findings. Univariate and multivariate analysis was performed to define predictive factors for malignancy.
RESULTS: Forty HI were hypovascular, 35 were benign (18 cysts, 12 focal fatty sparing, 1 fetal lobulation and 4 solitary necrotic nodules) and 5 cholangiocarcinomas (all resected)]. Eighty-one HI were hypervascular, 72 were benign [40 focal nodular hyperplasia (FNH), 8 adenoma and 24 hemangiomas) and 9 cancers (5 HCC, 4 metastases: 7 resected). Male gender [relative risk (RR) 2.70, confidence interval (CI) 1.69-3.51], age >45 years (RR 3.15, CI 2.71-3.89), tumour diameter >4 cm (RR 3.35, CI 3.13-4.01) and late (8 min) enhancement on magnetic resonace imaging (MRI) (RR 4.15, CI 3.01-4.79) were predictive of malignancy.
CONCLUSIONS: HI constitute 10% of practice volume. 10% of hyper and hypovascular incidental lesions are malignant. Most can be treated aggressively after diagnosis.