Role of liver biopsy in hepatocellular carcinoma

Abstract

The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known cirrhosis. In fact, in the diagnostic algorithm for this tumor, histology is currently relegated to controversial cases. Furthermore, the risk of complications, such as tumor seeding and bleeding, as well as inadequate sampling have further limited the use of liver biopsy for HCC management. However, there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and, as the information content of the tissue sample increases, the advantages of liver biopsy might modify the current risk/benefit ratio. We herein review the role and potentiality of liver biopsy in the diagnosis and management of HCC. As the potentiality of precision medicine comes to the management of HCC, it will be crucial to have rapid pathways to define prognosis, and even treatment, by identifying the patients who could most benefit from target-driven therapies. All of the above reasons suggest that the current role of liver biopsy in the management of HCC needs substantial reconsideration.

Hepatocellular Carcinoma: A Review

“…The Barcelona clinic liver cancer (BCLC) staging system (25) is most accepted in various guidelines and practiced (Figure 3). The staging in BCLC is linked to most appropriate therapy for HCC according to the stage of tumor which includes nodule size and number along <2 cm in size, predicting the prognosis of the lesion based upon certain genetic mutations and better selection of therapeutic modality based upon immunogenetics (21,22).…”

Extracellular Vesicles, A Possible Theranostic Platform Strategy for Hepatocellular Carcinoma—An Overview

“…A liquid biopsy is a revolutionary, minimally-invasive technique performed on samples of blood or other human fluids to detect and quantify circulating tumor cells (CTCs) or other tumor elements, such as cell-free tumor DNA (ctDNA) and extracellular vesicles (EVs), which are released in the blood or other human fluids by cancer cells. Thus, these tumor elements can be detected in the body fluids as a source of tumor tissue information in patients with different tumor types, including HCC [4,5]. Evaluation of CTCs, ctDNA, cell-free tumor DNA methylation, and circulating RNA as possible liquid-biopsy-based biomarkers in HCC could help improve the early diagnosis of HCC, in particular when it is multifocal or advanced, which are the most heterogeneous HCCs [6].…”

Identification of miR-4644 as a suitable endogenous normalizer for circulating miRNA quantification in hepatocellular carcinoma

“…For a long time, serological test, imaging examination, and tissue biopsy were several commonly used detection methods for clinical diagnosis and screening of HCC. But, higher false negative rate 6 , 7 , lower sensitivity 8 and greater trauma 9 are bottlenecks that restrict the development of these technologies. Therefore, it is particularly important to establish an early-warning system with high-efficiency and precision for the prevention and control of HCC.…”