Diagnosing hepatic lesions
As mentioned, diagnosing the type of liver lesion you might have is essential to deciding whether they should be left alone or treated. Such diagnosis depends on your symptoms, lab tests and imaging results. Not all liver lesions need all the available investigations, and your doctor will tailor such modalities to your condition.
Lab tests that may be needed include:
- Liver function tests: Liver function tests indicate the ability of the liver to produce certain proteins such as albumin and prothrombin. They also test the damage to the liver through liver enzymes (ALT and AST).
- Bilirubin levels: Bilirubin levels rise when the liver is damaged or when the flow of bile is obstructed. Both can occur in liver lesions and when it happens, jaundice occurs.
- Tumor markers: Tumor markers are certain proteins that may be secreted from tumor cells or as a response to the presence of a tumor. They are not used to diagnose a tumor alone, but to detect the stage of an already diagnosed one or to screen for its presence. They can also be used to detect recurrence of a resected tumor. In the case of liver tumors.
- Other routine lab tests: Other routine blood tests may be needed in such cases as a complete blood count and kidney function tests. They are usually ordered before an operation and can assess the general condition of a patient.
Imaging studies include:
- Abdominal ultrasound: Abdominal ultrasound is usually the first ordered imaging modality in liver conditions. It can help locate the lesion and give a general impression on its nature. The main advantage of it is that it is cheap and available everywhere, but it is less specific, and we cannot rely on it alone to exclude malignancy.
- CT scan: CT scan is more specific than ultrasound and can be used to determine whether a tumor is malignant or benign. It involves a high dose of radiation, however, and cannot be used in some conditions as in pregnant females.
- MRI: Magnetic resonance imaging can also be used instead of CT scanning in those who cannot tolerate the high-dose radiation of the latter.
The most decisive investigation to determine whether a tumor is benign or malignant is the biopsy. Liver biopsy involves taking a small sample of the liver using a special needle. Then, the sample is examined under the microscope to detect whether it is benign or malignant.