Is tumor biopsy necessary?

Müllhaupt, Beat; Durand, François; Roskams, Tania; Dutkowski, Philipp; Heim, Markus H.

doi:10.1002/lt.22374

Cited by 44 publications

(35 citation statements)

References 53 publications

(88 reference statements)

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“…Therefore, patients with negative biopsy findings should continue to undergo careful surveillance with repeated imaging. 23,[26][27][28] Biopsy is not indicated in following situations: A. if there is a focal lesion in a cirrhotic liver and the patient is not a candidate for any form of therapy B. in decompensated cirrhosis and the patient is on the waiting list for liver transplantation C. if the patient is a candidate for resection.…”

Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

“…28,31 In the single studies, the seeding risk varied from 0% to 5.1%, and the seeding occurred 3 months to 4 years after biopsy. The currently available evidence is grade B.…”

Section: Risk Of Needle Tract Seedingmentioning

confidence: 99%

“…27,32 In studies looking at the risk of seeding, a long follow-up period (up to 4 years) is essential. 28,33,34 In a large series, the incidence of needle tract seeding in more than 1000 patients with HCC was 0.76%. 34 Other studies with more than 100 patients have reported the incidence of tumor seeding following biopsy was in the range of 1.6%-3.4%.…”

Section: Risk Of Needle Tract Seedingmentioning

confidence: 99%

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Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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The current American Association for the Study of Liver Diseases (AASLD) guideline provides strategies for achieving the diagnosis of hepatocellular carcinoma (HCC) based on the size of liver nodules seen on surveillance imaging. For lesions less than 1 cm in size, follow-up surveillance imaging is recommended. Lesions larger than 2 cm require typical radiological hallmark on dynamic imaging. Lesions of 1-2 cm in size require typical imaging features including intense uptake of contrast during arterial phases followed by decreased enhancement during portal venous phases on at least 2 imaging modalities. In cases of atypical radiological features of the suspected lesion, tissue diagnosis either by fine needle aspiration or biopsy should be obtained. Although fine needle aspiration could give a smaller risk of seeding than biopsy, biopsy has been preferred over cytology. Percutaneous biopsy of HCC carries a potential risk of tumor seeding along the needle tract. However the risk is low and there is no clear evidence of post transplant recurrence due to needle tract seeding. Histopathologic assessment can differentiate between premalignant lesions such as dysplastic nodules and early HCC. Atypical variants of HCC can be recognized morphologically which may have associated prognostic value. ( J CLIN EXP HEPATOL 2014;4:S67-S73) H epatocellular carcinoma (HCC) is the sixth most common cancer in the world. 1 Its incidence is expected to rise in the future due to anticipated increase in cirrhosis secondary to viral hepatitis. Over the past 2 decades, the incidence of HCC has tripled, and hepatitis C virus (HCV) related HCC is the fastest-rising cause of cancer-related death in the United States. [2][3][4] Hepatocellular carcinoma develops within an established background of chronic liver disease in 70-90% of all patients. 5 The most frequent risk factor for HCC is chronic hepatitis B virus (HBV) infection in Asia and Africa. However HCV predominates as a risk factor in Europe and Japan. 2 Other well established risk factors are alcoholism, non-alcoholic fatty liver disease and diabetes. [6][7][8] Treatment depends on early diagnosis by screening high-risk patients when HCC is small and remains localized to the liver. Various studies suggest surveillance of HCC in cirrhotic patients irrespective of its etiology. Surveillance of non-cirrhotic patients is also advocated, especially in HBV carriers with serum viral load >10,000 copies/ml 9 or HCV infected patients with bridging fibrosis. Patients with HCV infection and advanced fibrosis remain at risk for HCC even after achieving sustained virological response following antiviral treatment.The preferred imaging method for screening is ultrasonography (USG) which is well tolerated and widely available. However, the sensitivity of USG for HCC detection is low because small nodules can be missed in a cirrhotic liver. 10 Use of contrast-enhanced USG improves the diagnostic performance of USG for HCC.The most used serological test in clinical setting for screening is alpha-fetop...

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Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

“…28,31 In the single studies, the seeding risk varied from 0% to 5.1%, and the seeding occurred 3 months to 4 years after biopsy. The currently available evidence is grade B.…”

Section: Risk Of Needle Tract Seedingmentioning

confidence: 99%

Section: Risk Of Needle Tract Seedingmentioning

confidence: 99%

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Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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“…5 To date, the debate on whether to biopsy has been dominated by voices that emphasize negative attributes of liver biopsy. The literature has placed less emphasis on the important positive aspects of histology, including its superior diagnostic sensitivity and specificity, long-term availability (e.g.…”

Section: Editor's Notementioning

confidence: 99%

“…In regards to tumor seeding, this event is rare, appears late, can be well treated locally in most cases, and does not reduce life expectancy. 5 Another concern of the current diagnostic approach is that clinical trial design mirrors the clinical diagnostic situation. If biopsies are not taken in the clinical setting, they are less likely to be implemented in clinical trials.…”

Section: Editor's Notementioning

confidence: 99%

Liver cancer biopsy – back to the future?!

Torbenson¹,

Schirmacher²

2015

Hepatology

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Liver Cancer Biopsy -Back to the Future?! H epatocellular carcinoma (HCC) is the only major cancer in which diagnosis and subsequent indication for treatment is not regularly established by histology. Current AASLD and EASL guidelines do not require biopsy for tumors that develop in cirrhotic livers and in chronic hepatitis B, if the imaging results show changes interpreted as HCC. This leads to an estimated 60-70% of nonresectable liver tumors being treated as HCC without tissue confirmation. Originally seen as an achievement, this approach neglects basic oncological principles and has had unforeseen negative consequences for diagnosis and treatment. At a time when oncology is moving towards personalized medicine, the lack of tissue in a large proportion of cases has significantly limited this approach for HCC. The foundation of personalized medicine is an integrative molecularmorphological subtyping of tumors using predictive molecular testing and targeted therapies. Other tumor entities, such as non-small-cell lung cancer, breast cancer, and colorectal carcinoma, have all witnessed improved integrative diagnostics, a flourishing trial scenario, novel predictive tests, innovative therapies, and an active bench-bedside-bench research scenario. Not so for HCC. What are the reasons? While there are many, we believe reduced numbers of tumor biopsies has been critical.Correct classification and subtyping of tumors is the foundation for rational therapy and the current WHO classification is based on integrated molecular and morphological data. This smart move has improved overall tumor definition and other organ systems have benefited enormously from this concept by the establishment of defined subtypes that require different approaches in diagnostics, treatment, and trial design. However, the effect for HCC has been limited to date, not because HCC is fundamentally different from other solid tumors, but due to a lack of interdisciplinary coevolution of diagnostics, culminating in a greatly reduced number of diagnostic liver biopsies.HCC is best considered not as a homogenous entity but as a closely related group of morphologically and molecularly distinct cancer subtypes. As one example, fibrolamellar carcinoma is already a well-accepted morphological and molecular subtype of HCC 1 ; furthermore, approximately 4-5% of liver cancers show both clear cut hepatocellular and cholangiocellular differentiation and are classified as combined HCC/CC. 2 In both cases, subtyping is clinically relevant and only established by histology. The importance of tumor subtyping will certainly increase in the future: even within the category of more typical HCCs, relevant morphological/molecular subtypes can be discerned. The new chromophobe subtype shows a distinct morphology as well as a specific molecular mechanism to overcome replicative senescence (alternative lengthening of telomeres), in contrast to telomerase activation seen in most HCCs. 3 The molecular mechanisms behind other subtypes, such as steatohepatitic, scirrhotic, and...

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2010 International consensus conference on liver transplantation for hepatocellular carcinoma: Texts of experts

Lesurtel¹,

Clavien

2011

Liver Transpl

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Is tumor biopsy necessary?

Cited by 44 publications

References 53 publications

Tissue Diagnosis of Hepatocellular Carcinoma

Tissue Diagnosis of Hepatocellular Carcinoma

Liver cancer biopsy – back to the future?!

2010 International consensus conference on liver transplantation for hepatocellular carcinoma: Texts of experts

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