肝脏局灶结节性过度增生在环磷酰胺或奥沙利铂化疗后患者随访中的表现：与肝转移的鉴别

在接受化疗的癌症幸存者随访期间新发现的肝结节可能带来诊断难题。我们研究了一系列由典型MRI特征、随访或病理诊断确认的肝脏局灶性结节性过度增生（FNH）。本回顾性研究评估了38例术后出现新肝脏FNH的肿瘤患者，患者接受了环磷酰胺（n=19）或奥沙利铂（n=19）为基础的化疗。主要肿瘤类型为乳腺癌（n=18）和结直肠癌（n=17）。报告了所有目标肝损的MRI表现、临床特征及其时间演变（n=63），并比较了两组化疗药物的差异。化疗完成至FNH检测的中位间隔为30.4个月（12.9，49.4）。6名患者接受了活检或手术，剩余患者通过典型MRI特征及长期随访诊断。患者中，60.5%（23/38）表现为多发结节，检测到63个靶损。靶损的中位大小为11.5mm（8.4，15.1）。中位随访时间为32.5个月（21.2，48.6），在随访期间有15名患者的损变发生变化（11增加，4减少）。环磷酰胺组患者年龄较年轻，女性比例较高，发现时间短于奥沙利铂组（全部p ≤ 0.016）。FNH可发生在环磷酰胺或奥沙利铂化疗后的癌症幸存者中。结合患者的治疗史和典型MRI表现，有助于避免误诊和不必要的侵入性治疗。癌症幸存者在随访期间出现新肝结节时，临床医生应考虑局灶性结节性过度增生的可能性，特别是如果患者曾接受环磷酰胺或奥沙利铂治疗。化疗后，癌症幸存者可能会发展为肝脏局灶性结节性过度增生。环磷酰胺和奥沙利铂是两种易引起局灶性结节性过度增生的化疗药物。在环磷酰胺治疗的患者中，FNH发生的间隔时间较短。

Newly detected hepatic nodules during follow-up of cancer survivors receiving chemotherapy may pose a diagnostic dilemma. We investigated a series of hepatic focal nodular hyperplasia (FNH) diagnosed by either typical MRI features and follow-up or pathology in cancer survivors.This retrospective study evaluated 38 patients with tumours who developed new hepatic FNH after cyclophosphamide-based (n = 19) and oxaliplatin-based (n = 19) chemotherapies. The main tumour types were breast cancer (n = 18) and colorectal cancer (n = 17). MRI findings, clinical features, and temporal evolution of all target hepatic lesions (n = 63) were reported. In addition, the two chemotherapy drug groups were compared.The median interval between chemotherapy completion and FNH detection was 30.4 months (12.9, 49.4). Six patients underwent biopsy or surgery, while the remaining patients were diagnosed based on typical MRI features and long-term follow-up. Among the patients, 60.5% (23/38) presented with multiple nodules and 63 target lesions were detected. The median size of target lesions was 11.5 mm (8.4, 15.1). The median follow-up time was 32.5 months (21.2, 48.6), and 15 patients experienced changes in their lesions during the follow-up period (11 increased and 4 decreased). The cyclophosphamide-based treatment group had a younger population, a greater proportion of females, and a shorter time to discovery than the oxaliplatin-based chemotherapy group (all p ≤ 0.016).FNH may occur in cancer survivors after cyclophosphamide- or oxaliplatin-based chemotherapy. Considering a patient's treatment history and typical MRI findings can help avoid misdiagnosis and unnecessary invasive treatment.When cancer survivors develop new hepatic nodules during follow-up, clinicians should think of the possibility of focal nodular hyperplasia in addition to liver metastasis, especially if the cancer survivors were previously treated with cyclophosphamide or oxaliplatin.Cancer survivors, after chemotherapy, can develop hepatic focal nodular hyperplasia. Cyclophosphamide and oxaliplatin are two chemotherapeutic agents that predispose to focal nodular hyperplasia development. Focal nodular hyperplasia occurs at shorter intervals in patients treated with cyclophosphamide.