Needle Tract Implantation After Sonographically Guided Percutaneous Biopsy of Hepatocellular Carcinoma: Evaluation of Doubling Time, Frequency, and Features on CT

Chang, Sun O; Kim, Seung Hoon; Lim, Hyo Keun; Lee, Won Jae; Choi, Dongil; Lim, Jae Hoon

doi:10.2214/ajr.185.2.01850400

Cited by 74 publications

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“…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%

“…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%. 35 Percutaneous biopsy of HCC carries a potential risk of tumor seeding along the needle tract.…”

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: Risk Of Needle Tract Seedingmentioning

confidence: 99%

Section: Risk Of Needle Tract Seedingmentioning

confidence: 99%

Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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“…One requirement for inclusion was that all malignancies needed to be proven by histology, and the needle type and the followup had to be known as well. They excluded all case reports and patients with seeding after ethanol 19 (2008) Systematic review Histology 3a Durand et al 13 (2001) Prospective and consecutive Histology Good Yes 1b Caturelli et al 12 (2004) Prospective and consecutive Histology Good Yes 1b Huang et al 17 (1996) Retrospective and nonconsecutive Histology Good Yes 3b Takamori et al 24 (2000) Retrospective and nonconsecutive Histology Good Yes 3b Maturen et al 23 (2006) Retrospective and nonconsecutive Histology Good Yes 3b Kosugi et al 22 (2004) Retrospective and nonconsecutive Histology Good Yes 3b Kim et al 21 (2000) Retrospective and nonconsecutive Histology Good Yes 3b Chapoutot et al 20 (1999) Retrospective and nonconsecutive Histology Good Yes 3b Chang et al 26 injection and radiofrequency ablation and all patients with suspected intrahepatic seeding. Finally, they included 8 studies, which were mostly retrospective cross-sectional studies.…”

Section: Question 2 What Are the Complications Of Tumor Biopsy?mentioning

confidence: 99%

“…12,13,17,[20][21][22][23][24] We identified 4 more studies. [25][26][27][28] Three of these studies were not analyzed because the reference standard was poorly defined 27,28 or some of the patients were not followed up. 25 In all, we included 1 systematic review and 9 single studies in the analysis (Tables 3 and 4).…”

Section: Question 2 What Are the Complications Of Tumor Biopsy?mentioning

confidence: 99%

Is tumor biopsy necessary?

et al. 2011

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“…Liver biopsy procedure is like any other procedure has some complications including but not limited to hemorrhage, perforation, infection, death and seeding of the tumors [4,5]. Very few cases reported the implantation/seeding of the original HCC following the liver biopsy or RFA and incidence is estimated to be 2.1-5% with a mean time for seeding is estimated between 8 and 48 months.…”

Section: Discussionmentioning

confidence: 99%

A Confusing Complication of Liver Biopsy: First Case Report of Seeding/ Implantation of Hepatocellular Carcinoma 9 Years from the Original Liver Biopsy

Al-Azzawi¹,

Mehta²

2017

J Liver

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The incidence of seeding/implantation of hepatocellular carcinoma (HCC) after liver biopsy or radio frequency ablation (RFA) is not well reported but estimated to be low. With the introduction of immunosuppression the risk has been increased and most of the seeding sites are chest wall and abdominal muscles. We report the first case report of HCC seeding after 9 years from the original liver biopsy.A 66 years old gentleman with cirrhosis secondary to hepatitis C virus infection and long history of alcohol abuse found to have a liver lesion during his screening by ultrasound and underwent percutaneous liver biopsy, which revealed hepatocellular carcinoma in 2006 and then the patient had a liver transplantation surgery in 2006 from cardiac death donor.The post transplantation course was uneventful and started on dual immunosuppression including Tacrolimus and Mycophenolate mofetil with acceptable levels through the whole treatment duration. All the follow up routine check ups including CT scan, liver biopsy, liver function tests and cancer screening were unremarkable and alphafetoprotein (AFP) was within acceptable level except slight increase in the AFP early 2015.His increase in AFP raised the concern for recurrence of HCC and his work up for possible recurrence or metastasis was negative including CT scan of the chest, abdomen and pelvis. Later in the 2015, the patient presented to his primary care physician complaining of right upper quadrant pain and swelling for which he underwent excisional biopsy of the skin. The skin nodule been fully resected and was 1.5 cm in diameter and its 10-15 cm from the original HCC. The pathology results of the specimen revealed that its metastatic hepatocellular carcinoma involving the subcutaneous tissue with negative margins, the immunostains were positive for Heppar1 immunestains and equivocal for glypican 3. This represents a local seeding of the original HCC 9 years after the liver biopsy location. This finding also was confirmed upon reviewing the images of the original HCC and the new metastatic HCC that showed it has same track of the liver biopsy in 2006.This case report is to increase the awareness of hepatologist and primary care physicians of the risk of skin HCC implantation and consider a routine check during the clinic visits in addition to the dermatologist skin screening visits. More research needed to investigate the rule of immunosuppression on seeding and implantation of HCC.

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Needle Tract Implantation After Sonographically Guided Percutaneous Biopsy of Hepatocellular Carcinoma: Evaluation of Doubling Time, Frequency, and Features on CT

Cited by 74 publications

References 18 publications

Tissue Diagnosis of Hepatocellular Carcinoma

Tissue Diagnosis of Hepatocellular Carcinoma

Is tumor biopsy necessary?

A Confusing Complication of Liver Biopsy: First Case Report of Seeding/ Implantation of Hepatocellular Carcinoma 9 Years from the Original Liver Biopsy

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