An algorithm for the accurate identification of benign liver lesions

Background: Benign liver lesions may be difficult to characterize preoperatively. In most instances, determination of the etiology of a hepatic mass makes its management decisions clear-cut. We present our experience using an algorithm for the management of liver masses of suspected benign or uncertain pathology and highlight this approach along with our surgical experience in benign liver lesions. Methods: Seventy-one patients underwent hepatectomy with a preoperative diagnosis of benign disease or unknown etiology from December 1992 to February 2002. Patients were preoperatively assessed with computed tomography, along with other imaging studies, as indicated. Final pathology was reviewed to confirm the preoperative diagnosis. Results: Ninety-two percent (65 of 71) were correctly characterized preoperatively. Diagnosis was inaccurate in 6 patients. Of these patients, final pathology revealed focal nodular hyperplasia in 4 patients. The remaining 2 patients, who had adenoma, were found to harbor malignancy within the surgical specimens. Conclusions: An algorithm to manage liver lesions resulted in a high diagnostic accuracy of a preoperative evaluation. Hepatic resection for benign disease can be performed with low morbidity and mortality and is highly successful in achieving relief for symptomatic patients.