Pulmonary nodules near fissures in hepatocellular carcinoma: assessing their clinical significance.

OBJECTIVE

To evaluate whether pulmonary nodules adjacent to fissures, particularly perifissural nodules detected on chest computed tomography in patients with hepatocellular carcinoma, can be reliably classified as benign based on their radiological characteristics.

METHODS

This retrospective cohort study included patients diagnosed with hepatocellular carcinoma (LI-RADS 5) between 2018 and 2022 at two reference hospitals. The patients underwent at least two follow-up chest computed tomography scans, with a minimum interval of 1 year, to identify at least one pulmonary nodule adjacent to the fissures. Statistical analyses were performed to assess the nodule classification, growth rates, and their association with metastatic progression.

RESULTS

In total, 55 patients (mean age 62.4±7.7 years) and 92 nodules were analyzed. Perifissural nodules were classified as typical (n=55, 59.8%), atypical (n=17, 18.5%), or non-perifissural nodule (n=20, 21.7%). Only two nodules (2.2%) progressed to metastasis: one non-perifissural nodule and one atypical perifissural nodule with histopathological confirmation. Statistical analysis did not reveal a significant association between perifissural nodule classification and metastatic progression (p=0.155); however, nodules that progressed to metastasis exhibited significantly higher annual growth rates (p<0.001).

CONCLUSION

Most perifissural nodules in patients with hepatocellular carcinoma showed radiological stability and did not progress to metastasis, indicating a low probability of malignancy. However, given the limited sample size and the number of metastatic events, these findings should be interpreted with caution. Typical perifissural nodules may be considered low risk, whereas atypical perifissural nodule and non-perifissural nodules require closer follow-up. Further studies are required to confirm these preliminary findings.