Follow-up for benign liver tumors?
Hello Doctor: I have a relatively large focal nodular hyperplasia (FNH) in my liver, and I have been regularly monitored at a major hospital since 2009.
The first MRI measured it at 9 cm, and the second MRI in 2010 measured it at 9.87 cm.
I asked the doctor why there was nearly a 1 cm difference in just one year, and the doctor mentioned it could be due to measurement error and advised to continue monitoring.
Since then, I have undergone ultrasound follow-ups every six months, and all reports indicated no abnormalities or enlargement.
Recently, I paid out of pocket for a full-body check-up at another hospital, which included an MRI, and this time in 2014, the FNH was measured at 10.7 cm! I would like to ask the doctor: 1.
Does this mean my FNH has grown, or could this still fall within the margin of error? 2.
Since MRI is more accurate than ultrasound, if the MRI shows my FNH has increased in size but the ultrasound does not, should the MRI results take precedence? Is this statement correct? 3.
If the FNH has indeed grown, although an increase of 1 cm over four years is relatively slow, my FNH is already quite large.
In this situation, would you recommend continuing observation, or should I consider surgical intervention? (I currently have no symptoms) Thank you!
JD, 30~39 year old female. Ask Date: 2014/02/20
Dr. Chen Qifeng reply Gastroenterology and Hepatology
Hello: 1.
Focal Nodular Hyperplasia (FNH) can indeed grow.
2.
It is also necessary to consider the Alpha-Fetoprotein (AFP) hepatitis marker.
3.
If it is liver cancer, MRI typically shows specific imaging characteristics.
4.
Symptoms are for reference only.
5.
If necessary, a biopsy or aspiration can be performed to assess the pathological condition.
Wishing you peace and health.
Dr.
Chi-Feng Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.
Reply Date: 2014/02/20
More Info
When it comes to monitoring benign liver tumors such as focal nodular hyperplasia (FNH), understanding the growth patterns and management strategies is crucial for patient safety and health. Based on your detailed history and the measurements provided, let's address your questions systematically.
1. Has my FNH grown, or is this within the margin of error?
The increase in size from 9 cm to 10.7 cm over several years does suggest a growth trend, but it is essential to consider the potential for measurement error. Imaging techniques like MRI and ultrasound can have variability due to factors such as the angle of measurement, the operator's technique, and the inherent limitations of each imaging modality. While a 1 cm increase over four years might seem significant, it is relatively slow for a benign tumor. In clinical practice, a growth of less than 2 cm over a year is often considered benign behavior, especially in the absence of symptoms. Therefore, while it appears that your FNH has grown, it is still within a range that could be attributed to measurement variability.
2. Is MRI more accurate than ultrasound, and should we prioritize MRI results?
Yes, MRI is generally considered more accurate than ultrasound for characterizing liver lesions, including FNH. MRI provides better soft tissue contrast and can help differentiate between benign and malignant lesions more effectively. If the MRI indicates a growth in size, it is reasonable to take that into account more heavily than ultrasound findings, especially if the ultrasound has not shown significant changes. However, it is also essential to correlate these findings with clinical symptoms and laboratory results, such as liver function tests and tumor markers like alpha-fetoprotein (AFP).
3. Should I continue to monitor the FNH, or is surgery advisable?
Given that you are asymptomatic and the growth has been relatively slow, continued observation is often the recommended approach for benign lesions like FNH. Surgical intervention is typically reserved for cases where the tumor causes symptoms (such as pain or pressure effects on adjacent organs), shows rapid growth, or raises concerns for malignancy. Since your FNH has been stable and you have no symptoms, regular follow-up with imaging (MRI or ultrasound) every 6 to 12 months is a prudent strategy. During these follow-ups, your healthcare provider will assess any changes in size or characteristics of the lesion.
In summary, while your FNH appears to have grown, the increase is gradual and may fall within the range of measurement error. MRI findings should be prioritized, but the absence of symptoms and the slow growth pattern suggest that continued monitoring is appropriate. Always maintain open communication with your healthcare provider, who can guide you based on the latest imaging results and any changes in your health status. Regular follow-ups will ensure that any significant changes are detected early, allowing for timely intervention if necessary.
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