Liver Masses: A Clinical, Radiologic, and Pathologic Perspective

Sudhakar K. Venkatesh; Vishal Chandan; Lewis R. Roberts


Clin Gastroenterol Hepatol. 2014;12(9):1414-1429. 

In This Article

Needle Biopsy, Histopathology, and Immunohistochemical Studies

Needle biopsies combined with histopathology and immunohistochemistry can be invaluable for characterizing liver masses. For suspected malignant masses, consideration should be given to whether a biopsy is necessary. Highly specific radiologic criteria have been established for the noninvasive diagnosis of HCC. These have been useful in reducing the need for biopsy in patients with cirrhosis who are eligible for liver transplantation and are at the highest risk for needle tract seeding and tumor recurrence owing to the immunosuppression after liver transplantation.[20] There is an approximately 10% false-negative rate with biopsy of small liver lesions as a result of difficulties with accurately targeting the lesion. On the other hand, biopsy is encouraged for diagnosis of patients with advanced disease who are not surgical resection candidates because newer molecular analyses may help determine the most appropriate chemotherapeutic agents. Overall, biopsies of malignant lesions carry a low risk of tumor seeding for suspected HCCs. However, for patients with suspected hilar cholangiocarcinomas under consideration for potentially curative resection or liver transplantation, transperitoneal fine-needle aspiration biopsy has been shown to be associated with a higher rate of peritoneal metastases.[21,22]