Percutaneous needle biopsies are frequently used to evaluate focal lesions of the liver. Needle-tract implantation of hepatocellular cancer has been described in case reports, but the true risk for this problem has not been clearly defined. We retrospectively reviewed 91 cases of hepatocellular cancer during a 4-year period from 1994 to 1997. Data on diagnostic studies, therapy, and outcome were noted. Of 91 patients with hepatocellular cancer, 59 patients underwent percutaneous needle biopsy as part of their diagnostic workup for a liver mass. Three patients (5.1%) were identified with needle-tract implantation of tumor. Two patients required en bloc chest wall resections for implantation of hepatocellular cancer in the soft tissues and rib area. The third patient, who also received percutaneous ethanol injection of his tumor, required a thoracotomy and lung resection for implanted hepatocellular cancer. Percutaneous needle biopsy of suspicious hepatic lesions should not be performed indiscriminately because there is a significant risk for needle-tract implantation. These biopsies should be reserved for those lesions in which no definitive surgical intervention is planned and pathological confirmation is necessary for a nonsurgical therapy. Copyright 2000 by the American Association for the Study of Liver DiseasesF ocal lesions of the liver often present challenging diagnostic and management problems. Incidental detection of hepatic lesions by the increasing use of modern imaging techniques further complicates the problem. The diagnostic armamentarium used to evaluate these lesions has been enhanced with the advent of computed tomographic (CT) scan and ultrasound-guided needle biopsy.Although percutaneous needle biopsy of the liver has been shown to be a generally safe procedure, serious complications have been reported. Complications include hemorrhage, biliary leak, pneumothorax, intrahepatic hematomas, diagnostic error, and needletract seeding. 1 Needle-tract seeding has been reported previously with a low incidence of 0.005% (3 of 63,108 cases). This study included, however, a large series of biopsies of many different organs (liver, pancreas, lymph nodes, kidney, spleen, and adrenal gland) performed for a variety of reasons, both neoplastic and nonneoplastic. 2 Several cases showing seeding of hepatocellular carcinoma during percutaneous procedures have been documented at our institution and have prompted closer scrutiny of this problem. MethodsAll patients referred to our group of surgeons with hepatocellular carcinoma over the 5-year period between January 1993 and December 1997 were the subjects of this study. Records were retrospectively reviewed for diagnostic studies, procedures performed, pathological examination, and outcome. Ninety-one patients with hepatocellular carcinoma were identified, and patterns of recurrence were noted. Three documented cases of needle-tract seeding were found and form the basis of this report. ResultsDuring the 5-year study period between January 1993 and December 1997, ...
Percutaneous needle biopsies are frequently used to evaluate focal lesions of the liver. Needle-tract implantation of hepatocellular cancer has been described in case reports, but the true risk for this problem has not been clearly defined. We retrospectively reviewed 91 cases of hepatocellular cancer during a 4-year period from 1994 to 1997. Data on diagnostic studies, therapy, and outcome were noted. Of 91 patients with hepatocellular cancer, 59 patients underwent percutaneous needle biopsy as part of their diagnostic workup for a liver mass. Three patients (5.1%) were identified with needle-tract implantation of tumor. Two patients required en bloc chest wall resections for implantation of hepatocellular cancer in the soft tissues and rib area. The third patient, who also received percutaneous ethanol injection of his tumor, required a thoracotomy and lung resection for implanted hepatocellular cancer. Percutaneous needle biopsy of suspicious hepatic lesions should not be performed indiscriminately because there is a significant risk for needle-tract implantation. These biopsies should be reserved for those lesions in which no definitive surgical intervention is planned and pathological confirmation is necessary for a nonsurgical therapy.
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