Is Routine Biopsy of Suspicious Liver Lesions Recommended?

Excerpt

A 66-year-old woman was referred for resection of a Hepatitis C-associated hepatocellular carcinoma (HCC), confirmed by percutaneous biopsy. She had a solitary tumour in segment III with characteristic CT imaging findings of HCC (Fig. 1; arterial phase enhancing lesion in segment III consistent with hepatocellular carcinoma (arrowhead)). On examination, a firm nodule was palpable in the anterior abdominal wall. Visible on concurrent CT imaging, it was suspicious for a biopsy-tract tumour deposit (Fig. 2; arterial phase enhancing anterior abdominal wall nodule corresponding to a biopsy-tract metastasis (arrow)). The patient had well-preserved liver function and underwent laparoscopic left lateral segmentectomy with wide excision of the subcutaneous nodule. Recovery was uneventful. Histopathology demonstrated poorly-differentiated HCC with macroscopic portal vein involvement (pT3b). The subcutaneous nodule was an identical, poorly-differentiated HCC, representing a distant metastasis. This changed the patient’s stage from IIIB to IVB with potentially significant implications for prognosis. Percutaneous biopsy of HCC is controversial. While biopsy is considered necessary before commencement of oncologic therapy, seeding carries serious implications for patients being considered for either resection or transplantation. Diagnostic biopsy alone is associated with a seeding rate in excess of 2 %, although incidence decreases when associated with therapeutic percutaneous intervention.1 With high-quality current and emerging imaging modalities,2 the diagnosis of HCC is reliable and screening is both safe and effective. Therefore, we recommend that percutaneous biopsy should not be performed routinely, reserving it for cases where diagnostic uncertainty persists.

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