Diagnosis of liver nodules observed in chronic liver disease patients during ultrasound screening for early detection of hepatocellular carcinoma

Am J Gastroenterol. 2002 Feb;97(2):397-405. doi: 10.1111/j.1572-0241.2002.05477.x.


Objectives: The aim of our study was to evaluate the nature of focal liver lesions detected during the ultrasound follow-up of a population (prevalently anti-hepatitis C virus [anti-HCV] positive) with chronic liver disease.

Methods: The study population consisted of 1827 consecutive newly diagnosed chronic liver disease cases without liver nodules at enrollment. Patients were screened at 4-month intervals by ultrasound and serum alpha-fetoprotein assessment. All lesions detected on imaging studies (except those accompanied by diagnostic a-fetoprotein levels) were subjected to biopsy (histology and cytology).

Results: During the 7-yr follow-up period (mean = 43.1 months), one or more solid focal lesions were found in 287 patients. a-Fetoprotein was diagnostic for hepatocellular carcinoma in 51 patients. Ultrasound-guided fine-needle biopsy was performed in the remaining 236 patients, yielding a diagnosis in 214: 198 hepatocellular carcinomas, 11 dysplastic nodules, and five B-cell non-Hodgkin's lymphomas (all confined to the liver and all in patients with chronic HCV infection). Twenty-two patients with nondiagnostic biopsies received diagnoses of hepatocellular carcinoma (20) or dysplastic nodules (two) based on arteriography or surgical biopsy.

Conclusions: Focal lesions arising in patients with HCV-related chronic liver disease can be other than hepatocellular carcinoma, and ultrasound-guided fine-needle biopsy plays an important role in their diagnosis. The prevalence of non-Hodgkin's lymphoma in this selected population was 0.31%. The fact that all five lymphoma patients had cirrhosis related to hepatitis C strengthens the hypothesis of an etiological correlation between the latter infection and B-cell lymphoproliferative disorders.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biopsy, Needle
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / pathology*
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / pathology*
  • Liver Function Tests
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / pathology*
  • Male
  • Middle Aged
  • Precancerous Conditions / pathology*
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Ultrasonography