Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy

Abstract

Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are probably underestimated. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, for defining indications for surgery in a cohort of patients with focal liver lesions (FLLs). Between January 1997 and December 1998, 160 consecutive patients carrying 225 FLLs admitted to our department were evaluated prospectively. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography, and spiral computed tomography (CT). Angiography, magnetic resonance imaging (MRI), and Lipiodol-CT were performed when it was considered necessary to plan the surgical strategy. All the patients underwent surgery and results of pathological examinations were obtained for all of them. The preoperative diagnoses of 221 of the 225 lesions (98.2%) were confirmed, and the indications for liver resection in 156 of the 160 patients (97.5%) were correct. The respective accuracy, sensitivity, specificity, and positive and negative predictive values were 99.6%, 100%, 98.9%, 99.3%, and 100% for diagnosis of hepatocellular carcinoma (HCC); 99.1%, 100%, 98.8%, 96.9%, and 100% for metastases; 99.6%, 100%, 99.5%, 91%, and 100% for cholangiocellular carcinomas (CCCs); all 100% for mixed HCC-CCCs; and 98.7%, 57.1%, 100%, 100%, and 98.6% for benign tumors. In view of these results, the fact that the real risks of FNB have yet to be established and the possibility that tumor seeding has a major impact on patient prognosis, the use of FNB should be drastically limited. (HEPATOLOGY 1999;30:889-893.)Differential diagnosis of focal liver lesions (FLLs) is not always easy, despite the progress made with the latest imaging techniques. 1,2 It is generally accepted that in most cases, fineneedle biopsy (FNB) is safe, accurate, and enables a definitive diagnosis to be made quickly. [3][4][5][6][7][8][9][10] However, some problems, such as the well known possibility of neoplastic seeding 11,12 and the conflicting results of diagnosis in patients with well-differentiated hepatocellular carcinomas (HCCs) 13-15 and benign tumors, 1,16 represent limitations that should be considered further. In particular, precise details of the prevalence of tumor cell seeding along the needle tract have yet to be determined, despite the fact that this problem is real 17 and its occurrence leads to a worse prognosis.Our diagnostic work-up for FLLs has never included FNB, and the aim of this study was to validate prospectively its accuracy for diagnosing FLLs, and consequently establishing the correct indications for surgery, in a cohort of patients admitted to our department. MATERIALS AND METHODSPatients were entered into the study if they satisfied the following selection criteria: (1) they were carrying hepatic solid nodules that had not been treated previously and (2) they had not undergone previous FNB of the liver. We considered the possibility of a selection bias owing to the fact that only patien...

Primary liver cancer and occupation in men: A case-control study in a high-incidence area in northern Italy

“…Finally, misclassification due to liver cancer misdiagnosis is unlikely since about 70% of PLC cases had a histologic/cytologic assessment and the remaining cases were diagnosed thorough validated biochemical and instrumental procedures. 41 Furthermore, separate analyses of cases with and without histologic assessment showed no differences in the prevalence of HBV and HCV infections and heavy alcohol consumption as well as no differences in the socio-demographic characteristics. Also, analysis restricted to histologically confirmed cases showed an OR of 1.8 (0.8 -4.1) for subjects exposed to xylene and toluene, which was similar to the OR found for the whole population.…”

Tissue Diagnosis of Hepatocellular Carcinoma

“…However controversies were raised over the role of FNA in the detection of HCC. 19 These include 1) high accuracy, sensitivity and specificity of dynamic imaging modalities, 20 2) the risk of needle tract seeding 21 3) intraprocedural hematogenous dissemination 21 4) need of accurate cytohistological characterization in small well-differentiated hepatocellular lesions. 22 All these reasons preclude use of pre-operative FNA diagnosis of HCC.…”

Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study

“…With these criteria, seven patients were excluded and 26 patients were enrolled for statistical analysis. The preoperative diagnosis of HCC was made based on dynamic imaging studies, biopsy, and alphafetoprotein serology according to American Association for the Study of Liver Diseases guideline [17,18]. The typical vascular pattern on dynamic imaging studies meant that the lesion was hypervascular in the arterial phase, and washed out in the portal/venous phase [18].…”