Article Text

Scoping review of clinical practice guidelines on the management of benign liver tumours
  1. Martijn P D Haring1,
  2. Frans J C Cuperus2,
  3. Evelien W Duiker3,
  4. Robbert J de Haas4,
  5. Vincent E de Meijer1
  1. 1Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
  2. 2Department of Hepatology and Gastroenterology, University Medical Centre Groningen, Groningen, The Netherlands
  3. 3Department of Medical Biology and Pathology, University Medical Centre Groningen, Groningen, The Netherlands
  4. 4Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Vincent E de Meijer;{at}


Objective Benign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.

Design A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.

Results The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.

Conclusion Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.

  • abdominal MRI
  • hepatic surgery
  • hepatoma
  • adenoma
  • liver imaging

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data are publicly available through the search query included in the methods section of the article.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data are publicly available through the search query included in the methods section of the article.

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  • RJdH and VEdM are joint senior authors.

  • RJdH and VEdM contributed equally.

  • Contributors No collaborators were involved in drafting the current manuscript, apart from the already registered coauthors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.