Routine Liver Biopsy of the Background Liver Is Potentially Useful in Patients with Hepatocellular Carcinoma
Liying Fu, Ahmed-Khalid Al-Omari, Kisha Mitchell, Tamar Taddei, Jeffrey Pollak, Dhanpat Jain. Yale New-Haven Hospital, New Haven, CT; Yale-New Haven Hospital, New Haven, CT
Background: In patients with hepatocellular carcinoma (HCC), treatment options depend not only on tumor characteristics, but also on the background liver. In many instances, confirmation of cirrhosis may limit potential for resection or necessitate liver transplantation listing. Though these are important considerations, routine biopsy of the non-tumoral parenchyma in the evaluation of liver masses has not been previously evaluated. The goal of this study was to evaluate the role of biopsying the background liver in patients with HCC.
Design: The pathology database was searched for liver biopsies with a diagnosis of HCC from 2000 to 2011. All available cases were divided into two groups. The first group (unpaired) comprised HCC patients with only liver mass biopsy while the second (paired) group comprised patients with biopsies available from the liver mass and the non-neoplastic liver. Demographic and treatment data was abstracted for both groups. The paired group was also evaluated for background chronic liver disease and/or cirrhosis, treatment proposed prior to biopsy, impact of biopsy results and treatment pursued after the biopsy.
Results: 28 unpaired and 20 paired liver biopsies were available for review. In the paired group, biopsies were performed simultaneously in 17 patients, 3 within 6 months of each other. All 14 cases of clinically suspected cirrhosis were confirmed on biopsy. Among the remaining 6 cases without a clinical suspicion of cirrhosis, cirrhosis was uncovered on biopsy in 1. In 3 patients (15%), treatment was altered by the background liver findings, which precipitated surgical management. In 2 patients, the overall management of liver disease was altered based on the background parenchymal biopsy results. Patients in the unpaired group tended to have more advanced disease (7/28 vs 1/20, p= 0.06, Fisher's exact test), when systemic therapy as initial treatment was used as a surrogate for advanced disease. Patients in the unpaired group were more often referred from outside our institution (19/28 vs 2/20; p<0.01, Fisher's exact test).
Conclusions: Though the status of background liver impacts the management of a minority of patients with HCC, this impact is significant in patients with early disease and may potentially trigger definitive treatment with curative intent. In a select population of HCC patients, biopsy of the background liver should be considered.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 189, Tuesday Morning