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

Martijn P.D. Haring; Robbert J. de Haas; 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 Meer; M. 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; M. C. Manuela; Collaborators

doi:10.1016/j.clinre.2023.102094

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

Martijn P.D. Haring, Robbert J. de Haas, 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 Meer, M. C. BurgmansR. 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, M. C. Manuela, Collaborators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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 language	English
Article number	102094
Journal	Clinics and research in hepatology and gastroenterology
Volume	47
Issue number	3
DOIs	https://doi.org/10.1016/j.clinre.2023.102094
Publication status	Published - 1 Mar 2023

Keywords

Focal nodular hyperplasia
Hepatic adenoma
Liver neoplasms
Surveys and questionnaires

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10.1016/j.clinre.2023.102094Licence: CC BY-NC-ND

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Haring, M. P. D., de Haas, R. J., van Vilsteren, F. G. I., Klaase, J. M., Duiker, E. W., Blokzijl, H., de Jong, K. P., de Meijer, V. E., Cuperus, F. J. C., de Boer, Y. S., de Man, R. A., den Hoed, C. M., Drenth, J. P. H., Garcovich, M. G., Gevers, T. J. G., Klompenhouwer, A. J., Kramer, M., Tushuizen, M. E., van der Meer, A. J., ... Collaborators (2023). Variation in the management of benign liver tumors: A European survey and case vignette study. Clinics and research in hepatology and gastroenterology, 47(3), Article 102094. https://doi.org/10.1016/j.clinre.2023.102094

@article{88a12d55506b4ef388c9529023d40d4d,

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

abstract = "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.",

keywords = "Focal nodular hyperplasia, Hepatic adenoma, Liver neoplasms, Surveys and questionnaires",

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

note = "Funding Information: The authors thank all participating experts for their response. Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = mar,

day = "1",

doi = "10.1016/j.clinre.2023.102094",

language = "English",

volume = "47",

journal = "Clinics and research in hepatology and gastroenterology",

issn = "2210-7401",

publisher = "Elsevier Masson",

number = "3",

}

Haring, MPD, de Haas, RJ, van Vilsteren, FGI, Klaase, JM, Duiker, EW, Blokzijl, H, de Jong, KP, de Meijer, VE, Cuperus, FJC, de Boer, YS, de Man, RA, den Hoed, CM, Drenth, JPH, Garcovich, MG, Gevers, TJG, Klompenhouwer, AJ, Kramer, M, Tushuizen, ME, van der Meer, AJ, Burgmans, MC, Cannella, RC, Caseiro-Alves, FC, Denecke, TD, Dwarkasing, RS, Fehrenbach, UF, Feshtali, S, Miclea, RL, Poyanli, AP, Ronot, MR, Sartoris, RS, Thomeer, M, van der Leij, C, van Koeverden, SK, Vermersch, MV, Vernuccio, FV, Willemssen, FEJA, Addeo, PA, Alexandrino, H, Belli, A, Bemelmans, MHA, Boleslawski, EB, Coelen, RJS, de Boer, MT, de Kleine, RH, den Dulk, M, Frilling, AF, Furumaya, A, Irinel, IP, Marc, JMJ, Manuela, MC & Collaborators 2023, 'Variation in the management of benign liver tumors: A European survey and case vignette study', Clinics and research in hepatology and gastroenterology, vol. 47, no. 3, 102094. https://doi.org/10.1016/j.clinre.2023.102094

TY - JOUR

T1 - Variation in the management of benign liver tumors

T2 - A European survey and case vignette study

AU - Haring, Martijn P.D.

AU - de Haas, Robbert J.

AU - van Vilsteren, Frederike G.I.

AU - Klaase, Joost M.

AU - Duiker, Evelien W.

AU - Blokzijl, Hans

AU - de Jong, Koert P.

AU - de Meijer, Vincent E.

AU - Cuperus, Frans J.C.

AU - de Boer, Y. S.

AU - de Man, R. A.

AU - den Hoed, C. M.

AU - Drenth, J. P.H.

AU - Garcovich, M. G.

AU - Gevers, T. J.G.

AU - Klompenhouwer, A. J.

AU - Kramer, M.

AU - Tushuizen, M. E.

AU - van der Meer, A. J.

AU - Burgmans, M. C.

AU - Cannella, R. C.

AU - Caseiro-Alves, F. C.

AU - Denecke, T. D.

AU - Dwarkasing, R. S.

AU - Fehrenbach, U. F.

AU - Feshtali, S.

AU - Miclea, R. L.

AU - Poyanli, A. P.

AU - Ronot, M. R.

AU - Sartoris, R. S.

AU - Thomeer, Maarten

AU - van der Leij, C.

AU - van Koeverden, S. K.

AU - Vermersch, M. V.

AU - Vernuccio, F. V.

AU - Willemssen, F. E.J.A.

AU - Addeo, P. A.

AU - Alexandrino, H.

AU - Belli, A.

AU - Bemelmans, M. H.A.

AU - Boleslawski, E. B.

AU - Coelen, R. J.S.

AU - de Boer, M. T.

AU - de Kleine, R. H.

AU - den Dulk, M.

AU - Frilling, A. F.

AU - Furumaya, A.

AU - Irinel, I. P.

AU - Marc, J. M.Jean

AU - Manuela, M. C.

AU - Collaborators

PY - 2023/3/1

Y1 - 2023/3/1

N2 - 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.

AB - 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.

KW - Focal nodular hyperplasia

KW - Hepatic adenoma

KW - Liver neoplasms

KW - Surveys and questionnaires

U2 - 10.1016/j.clinre.2023.102094

DO - 10.1016/j.clinre.2023.102094

M3 - Article

C2 - 36781070

SN - 2210-7401

VL - 47

JO - Clinics and research in hepatology and gastroenterology

JF - Clinics and research in hepatology and gastroenterology

IS - 3

M1 - 102094

ER -