Contemporary role of liver biopsy in hepatocellular carcinoma

Abstract

A correct diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy (LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities.

Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center

“…The rate of biopsy success, which was defined as providing sufficient amount of tissue for histopathologic confirmation of malignant lesion, was 93.4% in our study (93.6% in liver biopsies [US-guided], 89.7% in lung biopsies [CT-guided]). This figure is comparable or higher than those of previous studies on liver [11,12] and lung biopsies [13–16]. Various studies have investigated the factors affecting biopsy success rate, and reported that selecting appropriate target lesion is one of the most important steps for a successful biopsy [8,17].…”

Liquid Biopsies in Hepatocellular Carcinoma: Are We Winning?

“…The indications for tissue biopsy in HCC have evolved over time [7]. The development of high-throughput technologies has allowed the detection of molecular drivers of tumorigenesis and of specific DNA mutations in tumor biopsy samples, which may be able to predict response or resistance to targeted therapies [8].…”

Identification of hub genes in peripheral blood mononuclear cells for the diagnosis of hepatocellular carcinoma using a weighted gene co‑expression network analysis

“…Diagnosis of HCC relies on a number of different diagnostic methods, including ultrasound, computed tomography, biopsy and blood tests ( 2 ). Liver biopsy is regarded as the ‘gold standard’ for the diagnosis of HCC; however, liver biopsies are invasive procedures where the patient often experiences complications, such as bacteremia or death (risk of death, ~0.01%) ( 3 ). Similarly, there are certain disadvantages to ultrasound and computed tomography, which limit their effectiveness in the diagnosis.…”