Variation in the management of benign liver tumors: A European survey and case vignette study - 02/03/23

Doi : 10.1016/j.clinre.2023.102094

Martijn P.D. Haring ^a, Robbert J. de Haas ^b, Frederike G.I. van Vilsteren ^c, Joost M. Klaase ^a, Evelien W. Duiker ^d, Hans Blokzijl ^c, Koert P. de Jong ^a, Vincent E. de Meijer ^a,^{^{1
Shared senior authorship},}^⁎ , Frans J.C. Cuperus ^c,^⁎,^{^{1
Shared senior authorship}}
collaborators
Y.S. de Boer ^a, R.A. de Man ^b, C.M. den Hoed ^b, J.P.H. Drenth ^c, M.G. Garcovich ^d, T.J.G. Gevers ^e, A.J. Klompenhouwer ^b, M. Kramer ^e, M.E. Tushuizen ^f, A.J. van der Meer ^b, M.C. Burgmans ^g, R.C. Cannella ^h, F.C. Caseiro-Alves ⁱ, T.D. Denecke ^j, R.S. Dwarkasing ^k, U.F. Fehrenbach ^l, S. Feshtali ^g, R.L. Miclea, A.P. Poyanli ⁿ, M.R. Ronot ^o, R.S. Sartoris ^p, Maarten Thomeer ^k, C. van der Leij ^m, S.K. van Koeverden ^r, M.V. Vermersch ^s, F.V. Vernuccio ^t, F.E.J.A. Willemssen ^k, P.A. Addeo ^u, H. Alexandrino ^v, A. Belli ^w, M.H.A. Bemelmans ^x, E.B. Boleslawski ^y, R.J.S. Coelen ^z, M.T. de Boer ^aa, R.H. de Kleine ^aa, M. den Dulk ^x, A.F. Frilling ^bb, A. Furumaya ^cc, I.P. Irinel ^dd, J.M. Regimbeau ^ee, M.C. Manuela ^ff, İ. Özden ^gg, V.S. Sallinen ^hh, A.F. Schaapherder ⁱⁱ, M.S. Schmelzle ^jj, D. Seehofer ^kk, B. Trotovšek ^ll, S.T. Truant ^y, P.B. van den Boezem ^mm, B.V. van Rosmalen ^cc
^a Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Netherlands
^b Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Netherlands
^c Department of Gastroenterology and Hepatology, Radboud UMC, Netherlands
^d Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
^e Department of Gastroenterology and Hepatology, Maastricht University Medical Centre +, Netherlands
^f Department of Gastroenterology and Hepatology, Leiden University Medical Center, Netherlands
^g Department of Radiology, Leiden University Medical Center, Netherlands
^h Section of Radiology - Department of Biomedicine, University Hospital Paolo Giaccone, University of Palermo, Italy
ⁱ Department of Radiology, Coimbra University Hospital Center, Portugal
^j Department of Diagnostic and Interventional Radiology, University Medical Center Leipzig, Germany
^k Department of Radiology, Erasmus MC University Medical Center, Netherlands
^l Department of Radiology, Charité University Medicine Berlin, Germany
^m Department of Radiology, Maastricht University Medical Centre +, Netherlands
ⁿ Department of Radiology, İstanbul Medical Faculty, Turkey
^o Paris & Service de Radiologie, Université Paris Cité, Hôpital Beaujon, APHP.Nord, France
^p Department of Radiology, Hôpital Beaujon, Clichy, France
^r Department of Radiology, RadboudUMC, Netherlands
^s Department of Radiology, Lille University Medical Center, France
^t Department of Radiology, University Hospital of Padova, Italy
^u Hepato-Pancreato-Biliary Surgery and Liver transplantation, Hôpital de Hautepierre, Université de Strasbourg, France
^v Department of Surgery, Coimbra University Hospital Center, Portugal
^w Department of Surgery, National Cancer Institute - G. Pascale - IRCCS, Italy
^x Department of Surgery, Maastricht University Medical Centre +, Netherlands
^y Department of Surgery, Lille University Medical Center, France
^z Department of Surgery, Dijklander Ziekenhuis, Netherlands
^aa Department of Surgery, University Medical Center Groningen, Netherlands
^bb Department of Surgery, Imperial College London, United Kingdom (UK)
^cc Department of Surgery, Amsterdam University Medical Center, Netherlands
^dd Department of Surgery, Fundeni Clinical Instute, Romania
^ee Department of Surgery, Universitary Hospital Amiens, France
^ff Department of Surgery, Arnas Brotzu Cagliari, Italy
^gg Department of Surgery, Çam&Sakura Hospital and İstanbul Medical Faculty, Turkey
^hh Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Finland
ⁱⁱ Department of Surgery, Leiden University Medical Center, Netherlands
^jj Department of Surgery, Charité University Medicine Berlin, Germany
^kk Department of Surgery, University Hospital Leipzig, Germany
^ll Department of Surgery, University Medical Center Ljubljana, Slovenia
^mm Department of Surgery, RadboudUMC, Netherlands

^a Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
^b Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
^c Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
^d Department of Medical Biology and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

^⁎Corresponding authors.

Highlights

•	A European survey was performed among benign liver tumor experts.
•	The survey consisted of two parts: on local practices and case vignettes.
•	Our survey illustrates variability in FNH and HCA management in Europe.
•	Several areas were identified for future research and guideline recommendations, including FNH follow-up and the management of HCA >5 cm.
•	We propose the organization of Delphi consensus meetings to prioritize areas of research.

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Abstract

Background

Management of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), is multidisciplinary and subject to practice variation. We aimed to evaluate variation in clinical management of FNH and HCA in Europe.

Methods

We distributed an online survey (November 2021–March 2022) among 294 European experts. The survey included questions on local practice and included eight clinical vignettes. The clinical vignettes focused on FNH or HCA management in the setting of sex, lifestyle modification, and pregnancy.

Results

The response rate was 32% and respondents included surgeons (38%), gastroenterologists/hepatologists (25%), radiologists (32%), and pathologists (1.6%) from ten European countries. We observed practice variation with regard to lifestyle modification and imaging follow-up in patients with FNH, and with regard to the management of HCA >5 cm before and during pregnancy. Finally, the management of HCA >5 cm after lifestyle modification deviated from EASL guideline recommendations.

Conclusion

Our survey illustrates variability in FNH and HCA management in Europe. Several areas were identified for future research and guideline recommendations, including FNH follow-up and the management of HCA >5 cm. We propose the organization of Delphi consensus meetings to prioritize areas of research and update current guidelines to optimize management for all patients with benign liver tumors.

Le texte complet de cet article est disponible en PDF.

Keywords : Liver neoplasms, Hepatic adenoma, Focal nodular hyperplasia, Surveys and questionnaires

Abbreviations : BLT, FNH, HCA, OCP, CE-MRI, b-HCA, EASL, MDT, I-HCA, H-HCA, U-HCA, CEUS, US, CT, TAE

Plan

Introduction

Material and methods

Study design

Survey design and data collection

Statistical analyses

Results

Profile of respondents

Survey results part I; general questionnaire

Clinical management of FNH

Clinical management of HCA and pregnancy

Clinical management of large (>5 cm) HCA

Survey results part II: clinical vignette-based questionnaire

Conclusion

Sources of funding/grant support/This may be Funding Agency. Please check.financial disclosure

Data availability

CRediT authorship contribution statement

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Vol 47 - N° 3

Article 102094- mars 2023 Retour au numéro

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Variation in the management of benign liver tumors: A European survey and case vignette study - 02/03/23

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