EASL Clinical Practice Guidelines on the Management of Benign Liver Tumors

Watch a video presentation of this article Watch an interview with the author In August 2016, the European Association for the Study of the Liver (EASL) published a clinical practice guideline on the management of benign liver tumors. The guideline defines benign liver tumors as “a heterogeneous group of lesions with different cellular origins. Some of these lesions are of greater clinical relevance than others, and the aim of these recommendations is to provide a contemporary aid for the practical diagnosis and management of the more common benign tumors. These include haemangiomas, focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA).”1 The guideline includes a summary of epidemiological data, pathology, pathophysiology and natural progression, radiological features, and diagnostic criteria, as well as recommendations for management. The boxed recommendations and modified introduction have been included. After the discovery of a liver nodule, investigation is necessary to evaluate for conditions associated with liver lesions. In addition to considering chronic liver diseases, history should include medication review, travel history, and family history. Contrast-enhanced (CE) imaging should be done to characterize the lesion. This could include CE ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). MRI is preferable as a first-line assessment when a benign lesion is suspected. A possible malignancy must be excluded. If there is any doubt, the guideline recommends considering biopsy, but only after consideration by an experienced multidisciplinary team (MDT). The team should be one with expertise in the management of benign liver lesions and should include a hepatologist, a hepatobiliary surgeon, diagnostic and interventional radiologists and a pathologist. Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions. The team should be one with the skills required not only to appropriately manage these patients, but also manage the rare but known complications of diagnostic or therapeutic interventions. Reproduced with permission from Journal of Hepatology.1 Copyright 2016, European Association for the Study of the Liver. Reproduced with permission from Journal of Hepatology.1 Copyright 2016, European Association for the Study of the Liver. Reproduced with permission from Journal of Hepatology.1 Copyright 2016, European Association for the Study of the Liver. Reproduced with permission from Journal of Hepatology.1 Copyright 2016, European Association for the Study of the Liver. Reproduced with permission from Journal of Hepatology.1 Copyright 2016, European Association for the Study of the Liver. Please listen to Dr. Columbo discuss the important updates and impact on patient management from this publication.