Histologic differential diagnosis of focal liver lesions by ultrasonically guided fine needle biopsy.

Limberg, Bernd; Höpker, Wilhelm-Wolfgang; Kommerell, B.

doi:10.1136/gut.28.3.237

Cited by 40 publications

(13 citation statements)

References 14 publications

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“…21 However, FNB is a procedure that enables FLLs to be diagnosed accurately, with an overall accuracy of 90% to 95%, 6-10 a sensitivity of 85% to 90%, 3,8 and a specificity of 100%. 8,9 Recent studies using new techniques for sampling (2) 61 (61; 53-69) Hemangiomas (3) 27.7 (34; 14-35) Not correctly diagnosed (4) 17.8 (19.5; 6-26) NOTE. The statistical test used for performing analysis of variance was a unilateral F-test with the P value set at .5.…”

Section: Discussionmentioning

confidence: 99%

“…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][14][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.…”

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confidence: 99%

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

et al. 1999

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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...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 1999

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“…Histology is the gold standard in the differentiation of liver lesions. It is accepted that in most cases, percutaneous biopsy is safe, accurate, and enables a definitive diagnosis to be made quickly [7][8][9]. However, some problems, such as the possibility of neoplastic seeding, present limitations [10,11].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Diagnostic Criteria for Liver Metastases of Adenocarcinomas and Neuroendocrine Tumours at Conventional Ultrasound, Unenhanced Power Doppler Sonography and Echo-Enhanced Ultrasound

Rickes¹,

Ocran²,

Gerstenhauer³

et al. 2004

Dig Dis

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Purpose: In order to improve the differential diagnosis between liver metastases of neuroendocrine tumours and adenocarcinomas, criteria for the masses at conventional ultrasound, unenhanced power Doppler sonography and echo-enhanced ultrasound were evaluated. Methods: Seventy-three patients with histologically proven liver metastases of a neuroendocrine tumour (n = 26) or an adenocarcinoma (n = 47) were investigated by conventional ultrasound as well as unenhanced power Doppler sonography and echo-enhanced ultrasound focusing on specific properties of the lesions. Results: Liver metastases of neuroendocrine tumours and adenocarcinomas showed a different contrast behaviour with echo-enhanced sonography. A hypervascularisation at the arterial and capillary phase were found in 85% of the neuroendocrine metastases, and in 17% of the masses of adenocarcinomas, respectively (p < 0.05). Conclusions: The successful treatment of liver metastases requires a highly sensitive and specific diagnostic procedure for their differentiation. A hypervascularisation of the lesions during the arterial and capillary phase at echo-enhanced ultrasound may point to a neuroendocrine primary tumour. However, histology is the only standard of reference for the differentiation of liver metastases, and is necessary for optimal therapy.

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“…Some studies have reported that ultrasonically guided percutaneous fine needle biopsy is highly accurate and is rarely associated with fatal complications (41,42). With regard to biopsy specimens, tumor heterogeneity and unsteady VEGF expression within the same lesion may represent potential biases in our results.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Vascular Endothelial Growth Factor in Liver Metastases from Pancreatic Carcinoma as a Predictor of Chemotherapeutic Effect and Prognosis

Tawada¹,

Ishihara²,

Kobayashi³

et al. 2008

Clinical Cancer Research

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Purpose: In pancreatic carcinoma, vascular endothelial growth factor (VEGF) expression at the primary site has been suggested to be a prognostic parameter. We quantitatively analyzed VEGF expression in liver metastases from pancreatic carcinoma and examined the correlation among VEGF expression in liver metastases, clinicopathologic factors, and clinical outcome. Experimental Design: The subjects consisted of 23 patients with pancreatic adenocarcinoma who had liver metastases and were treated with S-1and gemcitabine as the first-line treatment. VEGF expression was quantitated by enzyme immunoassay in biopsy specimens of liver metastases and nontumorous liver tissue, and in plasma. In 10 of the 23 patients, VEGF expression was also quantitated in biopsy specimens of the primary pancreatic tumor. All samples were collected before treatment. Results:TheVEGF level in nontumorous liver tissue was 36.6 F 10.0 pg/mg protein versus 376.8 F 106.1pg/mg protein in liver metastases (P = 0.0016). PretreatmentVEGF levels in plasma and in primary pancreatic carcinoma did not correlate withVEGF levels in the corresponding liver metastases. The median VEGF level in liver metastases (138.9 pg/mg protein) was used as the cutoff value between high and low VEGF expression in liver metastases. Patients showing high VEGF expression had a significantly longer progression-free survival and overall survival than patients showing low VEGF expression in liver metastases (P = 0.0219 and P = 0.0074, respectively). Conclusions: Evaluation ofVEGF levels in liver metastases might be useful in assessing the prognosis of patients with metastatic pancreatic carcinoma who are under systemic chemotherapy.Pancreatic carcinoma is characterized by its aggressive course, and most patients present with advanced disease at the time of diagnosis (1). The liver is the most common and critical site for distant metastases, further affecting the prognosis of these patients.Angiogenesis is essential for the growth and metastasis of solid malignancies (2). Where pancreatic carcinoma is concerned, angiogenic factors such as vascular endothelial growth factor (VEGF) are usually investigated in the resected surgical specimen to assess angiogenesis (3 -7). In patients with pancreatic carcinoma who underwent surgical resection, it was found that the level of VEGF expression in the primary tumor was of prognostic value.Angiogenesis is also important for tumor growth at the metastatic site, and VEGF is thought to be closely related to angiogenesis at this site (8). To date, however, few studies have assessed VEGF expression in both the liver metastases and the primary pancreatic tumor in patients with metastatic pancreatic carcinoma. The purpose of this study was to investigate VEGF expression in liver metastases from pancreatic carcinoma obtained by percutaneous fine needle biopsy and its correlation with VEGF expression in the primary tumor, and to clarify its clinical significance. There were 14 men and 9 women, with a mean age of 60 y (range, 36-75 y). The...

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Histologic differential diagnosis of focal liver lesions by ultrasonically guided fine needle biopsy.

Cited by 40 publications

References 14 publications

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

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

Evaluation of Diagnostic Criteria for Liver Metastases of Adenocarcinomas and Neuroendocrine Tumours at Conventional Ultrasound, Unenhanced Power Doppler Sonography and Echo-Enhanced Ultrasound

Quantitative Analysis of Vascular Endothelial Growth Factor in Liver Metastases from Pancreatic Carcinoma as a Predictor of Chemotherapeutic Effect and Prognosis

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