MANAGEMENT OF FOCAL NODULAR HYPERPLASIA AND HEPATOCELLULAR ADENOMA INYOUNG-WOMEN - A SERIES OF 41 PATIENTS WITH CLINICAL, RADIOLOGICAL, AND PATHOLOGICAL CORRELATIONS

Preoperative distinction between focal nodular hyperplasia (FNH) that should be managed conservatively and hepatocellular adenoma (HA) that should be resected remains difficult. The result is controversial mana gement of these patients. The aims of this study were to report the va lue of modern imaging procedures for noninvasive diagnosis of these le sions, to assess the value of intraoperative frozen section studies, a nd to propose a management strategy in those patients. Forty-one conse cutive women with FNH (35 cases) or HA (6 cases) treated at our instit ution between 1985 and 1992 were studied. New imaging techniques, incl uding enhanced magnetic resonance imaging (MRI) and color Doppler ultr asonography (US), were prospectively appraised in addition to usual te chniques. Histological examination of surgical specimens was obtained in all cases. A sixfold increase in the number of patients with FNH wa s observed during this study, whereas the number of patients with HA d id not change. FNHs were incidental US findings in 74% of the cases. T he best imaging procedure in the diagnosis of FNH was enhanced MRI wit h a sensitivity of 70% and a specificity of 98%. Color Doppler US was a useful adjunct. Intraoperative frozen section studies were performed in 16 patients with 19 tumors with a sensitivity of 89% and a specifi city of 100%. From this study, we have come to the following conclusio ns: (1) in women, FNH is now much more often detected than HA; (2) usi ng enhanced MRI, a preoperative diagnosis of FNH is possible in 70% of the cases, avoiding unnecessary surgery; (3) when clinical, biochemic al, or imaging data are not typical of FNH, histological diagnosis is mandatory and can be safely and consistently made on large surgical bi opsy specimens; (4) during surgery, a decision to resect or not resect a lesion can be efficiently assisted by frozen-section studies.