Editorial: Not All Nodules Are Created Equal: A Personalized Approach to Indeterminate (<2 cm) Nodules Identified on HCC Surveillance.

Indeterminate small (<2 cm) nodules are often discovered in cirrhotics who undergo contrast enhanced imaging for further characterization of lesions detected on ultrasound surveillance for hepatocellular carcinoma (HCC). These are either arterially enhancing (without venous washout or capsule) or are non-enhancing (with washout). Differentials include small HCCs (14-23%), atypical arterio-portal shunts, regenerative, and dysplastic nodules. A risk score that combines imaging features (arterial enhancement and nodule size) with clinical (age, prior h/o HCC) and laboratory features (albumin, AFP, hepatitis B 'e' antigen) appear to be superior to radiological features alone in the risk stratification of these nodules.