Radiology

Glenn Krinsky, MD

Terminology of Hepatocellular Nodules in Cirrhosis: Plea for Consistency1

The cirrhotic liver is dened by the presence of nodules and brosis. A spectrum of nodules exists, ranging from the benign regenerative nodule to the malignant hepatocellular carcinoma (HCC). Prior to 1994, terminology existed with which the same nodule had multiple names. This resulted in confusion in interpreting investigators data in the pathology, radiology, and hepatology literature. In 1994, the International Working Party on Terminology met at the World Congress of Gastroenterology to establish a single nomenclature that would eliminate this confusion. The new terminology for cirrhotic nodules was developed and published in 1995 (1) (Table). The terminology included the benign regenerative nodule, low- and high-grade dysplastic nodules, dysplastic nodule with subfocus of HCC, and HCC. This terminology was introduced in radiology literature in this journal in 1996 by Earls et al (2) and was accompanied by an edTerminology of Hepatocellular Nodules in Cirrhosis
New Terminology Regenerative nodule Dysplastic nodule, low grade Dysplastic nodule, high grade Dysplastic nodule with subfocus of HCC HCC or small HCC (if 2 cm) Source.Reference 1. Old Terminology Regenerative nodule Macroregenerative nodule, type I; ordinary adenomatous hyperplasia Macroregenerative nodule, type II; adenomatous hyperplasia with atypia; borderline hepatocellular lesion Early HCC; adenomatous hyperplasia with microscopic HCC; macroregenerative nodule with microscopic HCC Adenomatous hyperplasia with macroscopic HCC; earlyadvanced HCC; advanced HCC; hepatoma

Index terms: Editorials Liver, cirrhosis, 761.794 Liver, nodules, 761.3198 Liver neoplams, 761.323 Radiology reporting systems Published online before print 10.1148/radiol.2243020008 Radiology 2002; 224:638
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From the Department of Radiology, New York University School of Medicine, 530 First Ave, Basement Schwartz Bldg, New York, NY 10016. Received February 1, 2002; accepted February 6. Address correspondence to the author (e-mail: glenn.krinsky @med.nyu.edu). RSNA, 2002

itorial by Wu and Boitnott (3). At the time, it seemed that this simplied terminology would transcend cultural and geographic boundaries and result in a universal language that all radiologists could readily understand. Six years have passed since the International Working Party terminology was introduced in our literature, yet it has failed to become a universal language. For example, an article published in the Journal of Computed Tomography in 2001 (4) used the confusing term borderline lesion. The term adenomatous hyperplasia was used in an article in Radiology in 2001 (5). Furthermore, it appears that some groups are creating new terminology; in 1999 (6), a review article in the American Journal of Roentgenology used the thoroughly confusing term dysplastic regenerative nodule. Why has the simplied terminology not gained universal use? One can only speculate that perhaps old habits die hard. Alternatively, radiologists may be bound by the terminology used by their pathologists. However, the continued use of antiquated, potentially confusing terminology may hinder our ability to advance the study of cirrhotic nodules. In April 2002, a new consensus group on

dysplastic nodules and HCC convened to reevaluate the Working Party terminology and will publish their results in the future. Until then, authors from all countries should adhere to the International Working Party Terminology when they submit relevant manuscripts to radiology journals.
References 1. International Working Party. Terminology of nodular hepatocellular lesions. Hepatology 1995; 22:983993. 2. Earls JP, Theise ND, Weinreb JC, et al. Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation. Radiology 1996; 201:207214. 3. Wu TT, Boitnott J. Dysplastic nodules: a new term for premalignant hepatic nodular lesions. Radiology 1996; 201:2122. 4. Rode A, Bancel B, Douek P, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001; 25:327336. 5. Pacella CM, Bizzarri G, Magnol, et al. Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients. Radiology 2001; 221:712720. 6. Dodd GD III, Baron RI, Oliver JH III, Federle MP. Spectrum of imaging ndings of the liver in end-stage cirrhosis: part II, focal abnormalities. AJR Am J Roentgenol 1999; 173:11851192.

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