Abstract
The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has changed
over time. The diagnostic algorithm for this tumor is nowadays mainly based on radiological
imaging, relegating histology to controversial cases, in which imaging techniques
cannot establish a clear-cut diagnosis. This most commonly happens in small lesions,
where biopsies frequently become mandatory, or in larger hypovascularized lesions.
In this case however, the histological examination may not be reliable enough to grade
the lesion, as different cell clones, deriving from sequential mutations, can originate
heterogeneous cell populations. The risk of complications of liver biopsy, such as
tumor seeding and intra-abdominal bleeding, needs to be reconsidered in light of new
scientific evidence and of the technical improvements that have been introduced. Furthermore,
increasing knowledge of the immunohistochemical and molecular characteristics of hepatocellular
carcinoma opens a new scenario in which biopsy may play a decisive role in defining
prognosis, and even treatment, by identifying the patient populations who could most
benefit from target-driven hepatocellular carcinoma treatments, and therefore improving
the success rate of experimental therapies. All the above reasons suggest that, overall,
the role of liver biopsy in the management of HCC needs a reappraisal.
Keywords
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Article info
Publication history
Published online: March 20, 2018
Accepted:
March 9,
2018
Received in revised form:
March 7,
2018
Received:
August 1,
2017
Identification
Copyright
© 2018 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
