Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
背景：局灶性结节增生（FNH）和肝细胞腺瘤（HCA）的治疗，是多学科的，受实践变化的影响。我们旨在评估欧洲FNH和HCA临床管理的差异。
方法：我们对294名欧洲专家进行了在线调查（2021年11月至2022年3月）。调查包括有关当地实践的问题，并包括八个临床小插曲。临床小插曲侧重于性别环境中的FNH或HCA管理，改变生活方式,和怀孕。
结果：反应率为32％，受访者包括外科医生（38％），胃肠病学家/肝病学家(25%)，放射科医师(32%),和来自十个欧洲国家的病理学家(1.6%)。我们观察到FNH患者在生活方式改变和影像学随访方面的实践变化，关于怀孕前和怀孕期间HCA>5cm的管理。最后,改变生活方式后HCA>5cm的管理偏离了EASL指南建议。
结论：我们的调查说明了欧洲FNH和HCA管理的差异。确定了未来研究和指南建议的几个领域，包括FNH随访和HCA>5cm的管理。我们建议组织Delphi共识会议，以优先考虑研究领域并更新当前指南，以优化所有良性肝肿瘤患者的管理。
方法：我们对294名欧洲专家进行了在线调查（2021年11月至2022年3月）。
结果：反应率为32％，受访者包括外科医生（38％），
结论：我们的调查说明了欧洲FNH和HCA管理的差异。
