Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit

Abstract

Background Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. Methods This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0–2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. Results Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. Conclusion The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy

Augmented Efficacy of Uttroside B over Sorafenib in a Murine Model of Human Hepatocellular Carcinoma

“…Moreover, the immunocompromised mice that were used for the induction of human HCC xenografts in the present study also exhibited symptoms of toxicity, even at the dose corresponding to the IC50 of sorafenib. Several other studies have also reported sorafenib-associated chemoresistance [ 23 , 24 ]. On the contrary, we have already shown that Utt-B is safe to mice even at elevated drug concentrations, authenticating the pharmacological safety of Utt-B over sorafenib [ 13 ].…”

The prime time for management of hepatocellular carcinoma in Hong Kong

“…14 In fact, a recent large retrospective analysis in UK has shown that around 10% of advanced-stage liver disease would receive an incorrect diagnosis based on non-invasive radiological criteria. 15 Second, given the increasing number of targeted therapy and immunotherapy for HCC, molecular subtyping of HCC is important to develop predictive biomarkers and the pursual of personalized treatment for HCC.…”

Incidence, Diagnosis, and Management of Hepatocellular Carcinoma: Current Perspectives and Future Direction

“…A large-scale multicenter study shows that serum DKK1, a Wnt/β-catenin signaling pathway inhibitor, could complement the diagnostic accuracy of AFP and improve the identification of patients with AFP-negative HCC and HCC from other chronic liver diseases [30] [8,2,4]. Biopsy in advanced liver disease is safe and overcomes the limitations of non-invasive criteria since diagnostic certainty is needed to ensure the appropriate use of systemic therapy [31,4]. Childs et al also confirmed that biopsy in advanced liver disease predicts positivity in ~ 91% of HCC cases which proves about 9% of patients would receive inappropriate therapy in the absence of biopsy [31,4].…”

“…Biopsy in advanced liver disease is safe and overcomes the limitations of non-invasive criteria since diagnostic certainty is needed to ensure the appropriate use of systemic therapy [31,4]. Childs et al also confirmed that biopsy in advanced liver disease predicts positivity in ~ 91% of HCC cases which proves about 9% of patients would receive inappropriate therapy in the absence of biopsy [31,4]. However, the sensitivity of these noninvasive criteria is only 33% since a negative biopsy does not rule out HCC [32].…”