Variation in the management of benign liver tumors: A European survey and case vignette study

Martijn P.D. Haring, Robbert J. de Haas, Collaborators, Frederike G.I. van Vilsteren, Joost M. Klaase, Evelien W. Duiker, Hans Blokzijl, Koert P. de Jong, Vincent E. de Meijer*, Frans J.C. Cuperus*, Y. S. de Boer, R. A. de Man, C. M. den Hoed, J. P.H. Drenth, M. G. Garcovich, T. J.G. Gevers, A. J. Klompenhouwer, M. Kramer, M. E. Tushuizen, A. J. van der MeerM. C. Burgmans, R. C. Cannella, F. C. Caseiro-Alves, T. D. Denecke, R. S. Dwarkasing, U. F. Fehrenbach, S. Feshtali, R. L. Miclea, A. P. Poyanli, M. R. Ronot, R. S. Sartoris, Maarten Thomeer, C. van der Leij, S. K. van Koeverden, M. V. Vermersch, F. V. Vernuccio, F. E.J.A. Willemssen, P. A. Addeo, H. Alexandrino, A. Belli, M. H.A. Bemelmans, E. B. Boleslawski, R. J.S. Coelen, M. T. de Boer, R. H. de Kleine, M. den Dulk, A. F. Frilling, A. Furumaya, I. P. Irinel, J. M.Jean Marc, B. V. van Rosmalen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Article number102094
JournalClinics and Research in Hepatology and Gastroenterology
Issue number3
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
The authors thank all participating experts for their response.

Publisher Copyright:
© 2023


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