Indication and contraindication for hepatic resection for liver tumors without fine-needle biopsy: Validation and extension of an Eastern approach in a Western community hospital

Abstract

Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are not negligible. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, not just to address but also to rule out from a surgical program patients with focal liver lesions (FLLs). From September 2001 to July 2003, 89 patients were seen at an outpatient clinic for FLLs. Nine patients were excluded because of previous FNB and 18 were excluded because carrier of advanced disease. Sixty-two patients with 101 FLLs were included. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography (US), and spiral computed tomography (CT). Other imaging modalities were carried out when it was considered necessary. Forty-eight patients underwent surgery, with histological confirmation of the preoperative diagnosis. The remaining 14 patients underwent a close follow-up. The preoperative diagnoses of 47 of the 48 patients who underwent surgery were confirmed (97.9%). All of the 14 patients ruled out for surgical treatment did not show FLL progression at 6-24 months of follow-up. Of the 9 patients who had FNB previously in other centers, 2 had a wrong histological diagnosis. In view of these results, a diagnostic work-up without FNB seems adequate either to include or to exclude patients with potentially resectable FLL from the surgical program and once more highlight the fact that the use of FNB should be drastically limited.

Liver Transplantation for Hepatocellular Carcinoma Without Preoperative Tumor Biopsy

“…Recent reports confirmed that such a policy seems justified in patients who present with a focal lesion and who are eligible for liver resection. Torzilli et al (16) prospectively showed that the preoperative diagnosis of HCC without biopsy could be confirmed on the resected specimen in 98% of the cases. Levy et al (15) also suggested that biopsy could be drastically limited before liver resection but for slightly larger lesions with a false-positive rate limited to 3.1% in nodules greater than 3 cm in diameter.…”

“…Similarly, Torzilli et al (16) have reported that a diagnosis work-up without biopsy seems adequate to operate or not in patients with potentially resectable focal liver lesion and once more highlighted that preoperative biopsy should be drastically limited.…”

A diagnostic paradigm for resectable liver lesions: to biopsy or not to biopsy?

“…In both groups, preoperative biopsy is associated with a poorer longterm outcome. Advances in imaging techniques have permitted preoperative characterization of solid lesions with a diagnostic accuracy equivalent to or greater than that of tissue biopsy and a maximum reported accuracy of 97.9% in a combination of contrast ultrasound, CT and MRI 68 . In cases of true diagnostic uncertainty with small lesions, we would advocate a ‘trial of time’ with early interval surveillance.…”

Complications of Liver Biopsy

“…It is clear that modern day practice of surgery dictates that all patients with liver lesions should be referred to a specialist centre for investigation and management. The advances in MRI, PET and CT along with ultrasound and measurement of tumour markers without histology have reported accuracies of over 97% and should provide enough information in the majority of cases for management decisions to be made (Torzilli, et al 2004). The only real indication for biopsy of suspicious liver lesions would be in patients who are considered to be irresectable by a specialist centre and a histological diagnosis is necessary to determine consideration for chemotherapy.…”