Guided liver biopsy of hepatic focal lesions in chronic liver disease patients: when and why?

ABSTRACT

Hepatocelluar carcinoma [HCC] is one of the most common malignant neoplasms in the world. To assess the value of the ultrasound or CT guided biopsy of hepatic focal lesion [s] with normal or mild elevation of serum alpha fetoprotein [below 200ng/mL] in the diagnosis of hepatocellular carcinoma. One-hundred twenty one chronic liver disease patients with hepatic focal lesion[s] and serum alpha fetoprotein below 200ng/ml were included in the present study. All patients were subjected to careful history taking and full clinical examinations, laboratory investigations [CBC, liver profile, hepatitis markers and serum AFP level], abdominal ultrasound, abdominal triphasic spiral computed tomography [CT] and biopsy of the hepatic focal lesion[s] guided by ultrasound for histopathological examination. According to the histopathological diagnosis of the lesion, patients were divided into non-HCC group [Group I] and HCC group [Group II] which included dysplastic nodules as well. Group I included a total of 29 patients -20 males [68.9%] and 9 females [31.1%] - aged between 30 and 68 [mean 51.7 +/- 9.3] years. Pathological examination of their liver biopsies revealed 14 cases as chronic hepatitis, 5 cases as liver cirrhosis, 5 cases as adenocarcinoma, 1 case as squamous cell carcinoma 2 cases as hemangioma and 1 case as cholangiocarcinoma and one case of lymphoma. Group II included a total of 92 patients -75 males [81.5%] and 17 females [18.5%] - aged between 36 and 74 [mean 55.0 +/- 8.8] years. Pathological examination of their liver biopsies revealed 88 cases as HCC and 4 cases as hepatic dysplastic nodules. The sensitivity and specificity of triphasic abdominal spiral CT in the diagnosis of HCC were 91.3% and 69.0% respectively, while, the positive and negative predictive values were 90.3% and 72.5% respectively. Guided liver biopsy of hepatic focal lesions in chronic liver disease patients has a valuable diagnostic role in cases with low alpha fetoprotein below 200ng/ml in whom the non-HCC nature is suspected and cases with negative or atypical HCC criteria in spiral abdominal CT