Department of Surgery, North Shore Hospital, Auckland, New Zealand.
HPB (Oxford). 2013 May;15(5):379-83. doi: 10.1111/j.1477-2574.2012.00595.x. Epub 2012 Oct 24.
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.
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.
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.
HI constitute 10% of practice volume. 10% of hyper and hypovascular incidental lesions are malignant. Most can be treated aggressively after diagnosis.
肝脏偶发瘤（HI）是在为其他疾病进行检查时偶然发现的无症状病变。本前瞻性系列研究总结了 121 例 HI 在 7 年时间里的管理和结局。
在 2003 年至 2010 年期间，为 1081 例接受肝切除术的患者中的 121 例患者进行了 HI 评估，对这些患者的数据进行了前瞻性记录。患者在多学科会议上进行了审查，并通过肿瘤标志物和影像学检查进行了检查。根据动脉期 CT 扫描结果，将 HI 分为低血管性或高血管性。进行单因素和多因素分析以确定恶性肿瘤的预测因素。
40 个 HI 为低血管性，35 个为良性（18 个囊肿、12 个局灶性脂肪保留、1 个胎儿叶状和 4 个孤立性坏死结节）和 5 个胆管癌（均切除）。81 个 HI 为高血管性，72 个为良性（40 个局灶性结节性增生（FNH）、8 个腺瘤和 24 个血管瘤）和 9 个癌症（5 个 HCC、4 个转移灶：7 个切除）。男性（RR 2.70，95%CI 1.69-3.51）、年龄>45 岁（RR 3.15，95%CI 2.71-3.89）、肿瘤直径>4 cm（RR 3.35，95%CI 3.13-4.01）和磁共振成像（MRI）晚期（8 分钟）增强（RR 4.15，95%CI 3.01-4.79）是恶性肿瘤的预测因素。
HI 占实践量的 10%。10%的高血管性和低血管性偶发病变是恶性的。大多数在诊断后可以积极治疗。
