The number of dysplastic nodules detected clinically has increased since pa
tients with hepatitis virus-associated cirrhosis, who are at increased risk
for hepatocellular carcinoma (HCC), began to undergo regular cancer survei
llance. Although it is potentially important to determine which type(s) of
nodule may be prone to progress to HCC, outcomes of dysplastic nodules have
not been fully investigated. This prompted us to examine the outcomes of d
ysplastic nodules in cirrhotic patients clinicopathologically. We studied 3
3 dysplastic nodules of <20 mm in maximum diameter, diagnosed by fine needl
e aspiration biopsy under ultrasonography (US). These nodules were clinical
ly followed, mainly by US examination, for up to 70 months. When the nodule
s enlarged or exhibited changes on US, they were histologically reexamined
by second biopsy. Surprisingly, 15 of the 33 nodules (45.5%) disappeared, 1
4 nodules (42.4%) remained unchanged, and only 4 nodules (12.1%) progressed
to HCC. The latter 4 nodules were an hyperechoic on US and were composed o
f clear cells with fatty change or small cells with increased nuclear densi
ty, and in all 4 patients serum was positive for hepatitis C virus antibody
. Univariate analyses revealed that, although not significant, the hyperech
oic nodules or nodules with small cell change showed a higher HCC progressi
on rate in comparison with the hypoechoic nodules or the nodules without sm
all cell change. In summary, most of the dysplastic nodules we followed dis
appeared or remained unchanged, but some progressed to HCC. Hyperechoic nod
ules in patients with hepatitis C virus-associated cirrhosis, which show sm
all cell change with increased nuclear density, may be prone to progress to
HCC.