Pre-operative liver biopsy in cirrhotic patients with early hepatocellular carcinoma represents a safe and accurate diagnostic tool for tumour grading assessment

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• 作者：Antonio Colecchia¹ ; ^{antonio.colecchia@aosp.bo.it} ; Eleonora Scaioli¹ ; Lucia Montrone¹ ; Amanda Vestito¹ ; Anna Rita Di Biase² ; Martina Pieri¹ ; Antonia D’ ; Errico-Grigioni³ ; Maria Letizia Bacchi-Reggiani⁴ ; Matteo Ravaioli⁵ ; Gian Luca Grazi⁵ ; Davide Festi¹
• 关键词：Liver resection ; Liver transplantation ; Hepatocellular carcinoma ; Liver cirrhosis ; Liver biopsy
• 刊名：Journal of Hepatology
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：54
• 期：2
• 页码：300-305
• 全文大小：606 K

文摘

Background & Aims

Knowledge of pre-operative tumour grade is crucial in the management of hepatocellular carcinoma (HCC) because it can influence recurrence and survival after surgery. The accuracy of pre-operative needle core biopsy (NCB) in tumour grading has been assessed in only a few studies with conflicting results.

Our aim was to determine the long-term safety and the overall accuracy of NCB in assessing tumour grading in subjects who had undergone liver resection for a single HCC.

Methods

Eighty-one cirrhotic patients with HCC who had undergone NCB before liver resection were selected. Only patients with a single HCC and with at least a five-year-follow-up were included. Tumour grading was scored according to a modified Edmondson–Steiner classification: well/moderately (low grade) vs poorly-differentiated (high grade).

Results

In the 81 patients with a solitary HCC (mean size 4.1 ± 2.3 cm) tumour grade was correctly identified by NCB in 74 out of 81 (91.4 % ) HCCs. NCB overall sensitivity and specificity were 65 % and 98.1 % , respectively, with a PPV of 92 % and an NPV of 91 % . No major complications (in particular tumour seeding) were observed. The overall survival rates at 1, 3, and 5 years were 83 % , 62 % , and 44 % , respectively; the recurrence rate after a 5-year-follow-up was 56.2 % for low grade and 82.3 % for high grade tumours (p <0.007).

Conclusions

Pre-operative NCB can be performed on early (<5 cm) HCC cirrhotic patients because it provides histologically useful information for HCC management with good accuracy and a low complication rate.