Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;8(1):e000592.
doi: 10.1136/bmjgast-2020-000592.

Scoping review of clinical practice guidelines on the management of benign liver tumours

Martijn P D Haring  1 , Frans J C Cuperus  2 , Evelien W Duiker  3 , Robbert J de Haas #  4 , Vincent E de Meijer #  5
Affiliations

Scoping review of clinical practice guidelines on the management of benign liver tumours

Martijn P D Haring et al. BMJ Open Gastroenterol. 2021 Aug.

Abstract

Objective: Benign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.

Design: A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.

Results: The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.

Conclusion: Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.

Keywords: abdominal MRI; adenoma; hepatic surgery; hepatoma; liver imaging.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of systematic literature search.
Figure 2
Figure 2
AGREE II scores of guidelines on benign liver tumours AGREE II scores per domain as assessed by two reviewers. Domain scores calculated as instructed in AGREE II protocol. ACG, American College of Gastroenterology; EASL, European Association for the Study of the Liver; SBH, Brazilian Society of Hepatology.
See this image and copyright information in PMC

References

    1. Gore RM, Pickhardt PJ, Mortele KJ, et al. . Management of incidental liver lesions on CT: a white paper of the ACR incidental findings Committee. J Am Coll Radiol 2017;14:1429–37. 10.1016/j.jacr.2017.07.018 - DOI - PubMed
    1. Koea JB. Hepatic incidentaloma: the rule of TENS. HPB 2013;15:379–83. 10.1111/j.1477-2574.2012.00595.x - DOI - PMC - PubMed
    1. Kaltenbach TE-M, Engler P, Kratzer W, et al. . Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol 2016;41:25–32. 10.1007/s00261-015-0605-7 - DOI - PMC - PubMed
    1. Hoekstra LT, Bieze M, Erdogan D, et al. . Management of giant liver hemangiomas: an update. Expert Rev Gastroenterol Hepatol 2013;7:263–8. 10.1586/egh.13.10 - DOI - PubMed
    1. Roncalli M, Sciarra A, Tommaso LD, Di TL. Benign hepatocellular nodules of healthy liver: focal nodular hyperplasia and hepatocellular adenoma. Clin Mol Hepatol 2016;22:199–211. 10.3350/cmh.2016.0101 - DOI - PMC - PubMed

Publication types