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Borzio et al. Hepatoma Res 2019;5:15 I http://dx.doi.org/10.20517/2394-5079.2019.11 Page 13 of 16

LG- and HG-DN, being the latter the true HCC precursors. Although relevant advances have been obtained
in the last 2 decades as to morphology, and radiologic behaviour of these precursors, their management
still represents a challenge for clinicians, radiologists and pathologists. In particular, major difficulties arise
in surgical and transplant setting where experts have to face with these small lesions and make decisions
[90]
about early treatment or simple observation without impacting negatively on the single patient outcome .
This remain an open and hot issue and efforts of scientific community are targeted to search and validate
radiological and tissue markers helping to select lesions more prone to evolve into well-established HCC
and deserving early treatment. Due to the limitations of biopsy and considering the complexity of radiologic
work up, strict follow-up remains the most reliable alternative and the nodule growth the most confident
and easy-to-use parameter driving decision-making process.

DECLARATIONS
Authors’ contributions
Planned the review: Borzio M
Performed data research and data extraction: Borzio M, Francica G
Drafted the manuscript and approved the final version of the manuscript: Borzio M, Paladino F, Francica G
Controlled for data extraction: Borzio M, Paladino F, Francica G

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Arakawa M, Kage M, Sugihara S, Nakashima T, Suenaga M, et al. Emergence of malignant lesions within an adenomatous
hyperplastic nodule in a cirrhotic liver. Observations in five cases. Gastroenterology 1986;91:198-208.
2. Sakamoto M, Hirohashi S, Shimosato Y. Early stages of multistep hepatocarcinogenesis: adenomatous hyperplasia and early
hepatocellular carcinoma. Hum Pathol 1991;22:172-8.
3. Kudo M. Multistep human hepatocarcinogenesis: correlation of imaging with pathology. J Gastroenterol 2009;44 Suppl 19:112-8.
4. International Working Party. Terminology of nodular hepatocellular lesions. Hepatology 1995;22:983-93.
5. Borzio M, Fargion S, Borzio F, Fracanzani AL, Croce AM, et al. Impact of large regenerative, low grade and high grade dysplastic
nodules in hepatocellular carcinoma development. J Hepatol 2003;39:208-14.
6. Caturelli E, Solmi L, Anti M, Fusilli S, Roselli P, et al. Ultrasound-guided fine needle biopsy of early hepatocellular carcinoma
complicating liver cirrhosis: a multicentre study. Gut 2004;53:1356-62.
7. Bolondi L, Gaiani S, Celli N, Golfieri R, Grigioni WF, et al. Characterization of small nodules in cirrhosis by assessment of
vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 2005;42:27-34.
8. Forner A, Vilana R, Ayuso C, Bianchi L, Solè M, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective
validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008;47:97-104.
9. Sangiovanni A, Mannini MA, Iavarone M, Romeo R, Forzenigo LV, et al. The diagnostic and economic impact of contrast imaging