Abstract
Background
Despite improvements in imaging techniques that have enhanced the ability to diagnose hepatocellular carcinoma (HCC), histopathological evaluation of many other types of liver masses is critical.
Aims
To evaluate the utility of liver biopsy in patients with radiologically undiagnosed liver masses.
Methods
We retrospectively analyzed 293 consecutive patients who had a liver biopsy for evaluation of an undiagnosed liver mass between January 2014 and January 2018.
Results
Out of 293 biopsies, 246 patients were found to have malignancy (84%), including 210 (72%) patients with metastatic malignancy and 36 with primary hepatic malignancies (20 HCC and 16 others). In the 47 patients without malignancy, 17 patients had necrotic abscess/granuloma, 16 patients had normal histology, eight patients had hepatic fibrosis/cirrhosis without malignant foci, and six patients had benign tumors. The most common primary lesion in patients with liver metastasis was breast carcinoma (32/293, 11%), followed by colon and pancreas (31 (each)/293, 11%), and lung (9%) adenocarcinomas. Histopathological analysis confirmed the presence of metastasis in 165/200 (83%) patients with a history of oncological malignancy and in 45/93 (48%) patients who had no malignancy history.
Conclusions
In patients with a radiologically identified liver mass of unclear etiology, liver biopsy/histology made a diagnosis in 95% (277/293) of patients, including 84% (246/293) found to have an oncological malignancy. Liver biopsy/histology also identified malignancy in a high proportion of patients without known underlying cancer. We conclude that liver biopsy is valuable for evaluation of radiologically identified liver masses of unclear etiology.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gore RM, Pickhardt PJ, Mortele KJ et al. Management of incidental liver lesions on ct: a white paper of the ACR incidental findings committee. JACR. 2017;14:1429–1437
Khalifa A, Rockey DC. The utility of liver biopsy in 2020. Curr Opin Gastroenterol. 2020;3:184–191
Hugen N, van de Velde CJ, de Wilt JH, Nagtegaal ID. Metastatic pattern in colorectal cancer is strongly influenced by histological subtype. Ann Oncol Off J Eur Soc Med Oncol. 2014;25:651–657
de Ridder J, de Wilt JHW, Simmer F, Overbeek L, Lemmens V, Nagtegaal I. Incidence and origin of histologically confirmed liver metastases: an explorative case-study of 23,154 patients. Oncotarget. 2016;7:55368–55376
Venkatesh SK, Chandan V, Roberts LR. Liver masses: a clinical, radiologic, and pathologic perspective. Clin Gastroenterol Hepatol. 2014;12:1414–1429
Boyum JH, Atwell TD, Schmit GD et al. Incidence and risk factors for adverse events related to image-guided liver biopsy. Mayo Clin Proc. 2016;91:329–335
Gorog D, Toth A, Weltner J. Prognosis of untreated liver metastasis from rectal cancer. Acta Chirurgica Hungarica. 1997;36:106–107
Hoe AL, Royle GT, Taylor I. Breast liver metastases–incidence, diagnosis and outcome. J R Soc Med. 1991;84:714–716
Yu SC, Liew CT, Lau WY, Leung TW, Metreweli C. US-guided percutaneous biopsy of small (< or = 1-cm) hepatic lesions. Radiology. 2001;218:195–199
Pereira-Lima JE, Lichtenfels E, Barbosa FS, Zettler CG, Kulczynski JM. Prevalence study of metastases in cirrhotic livers. Hepato-gastroenterology. 2003;50:1490–1495
Chiou W-Y, Chang C-M, Tseng K-C et al. Effect of liver cirrhosis on metastasis in colorectal cancer patients: a nationwide population-based cohort study. Jpn J Clin Oncol. 2014;45:160–168
Howlett DC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part II: minor and major complications and procedure-related mortality. Radiology. 2013;266:226–235
McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology. 1990;99:1396–1400
Mueller M, Kratzer W, Oeztuerk S et al. Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years. BMC Gastroenterol. 2012;12:173
Tung WC, Huang YJ, Leung SW et al. Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy. Liver Int Off J Int Assoc Study Liver. 2007;27:192–200
Sparchez Z, Mocan T, Hagiu C et al. Real-time contrast-enhanced-guided biopsy compared with conventional ultrasound-guided biopsy in the diagnosis of hepatic tumors on a background of advanced chronic liver disease: a prospective, randomized. Clini Trial Ultrasound Med Biol. 2019;45:2915–2924
Author information
Authors and Affiliations
Contributions
AK contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. Email: khalifa@musc.edu. RS contributed to study concept and design; acquisition of data. Email: sasso@musc.edu. DR contributed to study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content, supervisory efforts; and study oversight. Email: rockey@musc.edu.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Khalifa, A., Sasso, R. & Rockey, D.C. Role of Liver Biopsy in Assessment of Radiologically Identified Liver Masses. Dig Dis Sci 67, 337–343 (2022). https://doi.org/10.1007/s10620-021-06822-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-021-06822-9