The Feasibility of Liver Biopsy for Undefined Nodules in Patients under Surveillance for Hepatocellular Carcinoma: Is Biopsy Really a Useful Tool?

Abstract

The aim of the present study is to determine the feasibility of biopsy for atypical liver nodules in patients under surveillance for hepatocellular carcinoma (HCC), assessing which factors influence the decision to perform it. Methods: A total of 128 atypical liver nodules in 108 patients under surveillance for HCC, who underwent CT between September 2018 and September 2019, were included. All the images were saved digitally (on CD-ROM) and the two most representative images in the arterial and delayed phases were selected for each lesion and inserted into a digital atlas (on PDF). Two experienced radiologists (Readers 1 and 2) reviewed both the CD-ROM and the PDF to define the feasibility of biopsy in both scenarios, specifying the reasons for the unfeasibility of biopsy. The intra-observer variability and inter-observer variability were assessed. Results: When reviewing the PDF, 76 (59.4%) and 68 (53.1%) nodules were deemed unfeasible for biopsy by the less experienced radiologist (Reader 1) and the more experienced radiologist (Reader 2), respectively (p = 0.604). When reviewing the entire CT study, both percentages decreased slightly (Reader 1 = 70/128 (54.7%); Reader 2 = 61/128 (47.6%); p = 0.591). The intra-reader agreement on the PDF was substantial (k = 0.648 (95% CI = 0.513–0.783)). The inter-reader agreement on the PDF was slight (k = 0.185 (95% CI = 0.021–0.348)) and moderate on the entire CT study (k = 0.424 (95% CI = 0.269–0.579)). When assessing the PDF, the nodule size (10–20 mm) and location in segments six and eight were negatively and positively associated with the feasibility of liver biopsy, respectively. When assessing the CD-ROM, only the nodule dimension was associated with the unfeasibility of liver biopsy. Conclusions: The unfeasibility of liver biopsy is mainly due to the small size of the lesions and their location.

LI-RADS LR-5 on contrast-enhanced ultrasonography has satisfactory diagnostic specificity for hepatocellular carcinoma: a systematic review and meta-analysis

“…Owing to the characteristic imaging patterns of HCC, most patients are diagnosed before surgery on the basis of radiologic findings detected during enhanced computed tomography (CT) or enhanced magnetic resonance imaging (MRI) examinations, for example (2,3). Moreover, the tendency of uncontrollable hemorrhage, the possibility of biopsy-related tumor metastasis, and the likelihood of false negative results due to the size and location of nodules mean that imaging techniques are safer and more convenient presurgical procedures for the diagnosis and evaluation of HCC than other diagnostic methods such as needle biopsy (4).…”

Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis

“…The definitions used for defining limited visualization in aMRI were heterogenous, and a consensus, standardized definition is required. We were unable to investigate the effect of tumour size on visualization quality due to a lack of data, although previous studies have demonstrated reduced sensitivity of imaging techniques for the detection of small lesions from 10 to 20 mm, especially for lesions less than 10 mm [51–53]. Finally, there were insufficient studies to perform subgroup analysis among patients without cirrhosis and by aetiology.…”

Current Concepts of Precancerous Lesions of Hepatocellular Carcinoma: Recent Progress in Diagnosis

“…Intra-nodular vascular alterations occur during hepatocarcinogenesis, with a progressive reduction in the portal blood supply and a concomitant rise in the arterial flow delivered by the so-called “unpaired” arteries. The arterial phase hyperenhancement (APHE) and wash-out of the contrast medium in the portal and/or delayed phases are the classic radiologic characteristics of HCC, which are caused by vascular derangement [ 63 ]. The typical radiographic characteristics of “wash-in” and “wash-out” are adequate for recognizing HCC in nodules larger than 10 mm, and a biopsy should only be considered for nodules with atypical imaging characteristics [ 64 , 65 ].…”