[Diagnosis and treatment of hepatocellular adenoma in the Netherlands: similarities and differences].

OBJECTIVE

To establish the current expert opinions on the diagnosis and treatment of hepatocellular adenoma in the Netherlands.

DESIGN

Questionnaire.

METHOD: In 2005, a questionnaire concerning the incidence, diagnosis, treatment, management in case of pregnancy, and follow-up of hepatocellular adenoma was sent to 20 Dutch hospitals with a tertiary referral role. In addition, they were asked to describe the indicated treatment in 5 imaginary cases.

RESULTS

17 hospitals (85%) responded. A median of 52 patients per hospital presented with a solid liver tumour annually. Between 1 and 40% of these patients had benign lesions with a differential diagnosis of adenoma, focal nodular hyperplasia, and haemangioma. In 15 clinics (88%), hepatic adenomas were diagnosed with contrast-enhanced, multiphasic, spiral CT or MRI series. 2 clinics (12%) required a histological diagnosis. Conservative management (withdrawal of oral contraceptives and radiological control) was initially given in all clinics. MRI, CT or ultrasound were used to follow adenoma patients with different time schedules. The criteria for surgical resection were a tumour size > 5 cm and abdominal complaints. In 5 clinics (29%), the patients were no longer followed after surgery. In cases in which multiple factors played a role (size, location, number of lesions, and wish to become pregnant), the treatment policy was highly variable. Pregnancy was not discouraged in 15 clinics, but in 11 (65%) only under strict conditions: frequent control, a peripheral location that makes surgery possible if necessary, a stable tumour size, and an understanding of the risks.

CONCLUSION

The management of hepatocellular adenomas in the Netherlands is rather uniform, except for differences in the methods of observation and the treatment policy in cases in which multiple factors play a role.