Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2018; 24(35): 4000-4013
Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4000
Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma
Archana Rastogi
Archana Rastogi, Department of Pathology, Institute of Liver & Biliary Sciences, New Delhi 110070, India
Author contributions: Rastogi A conceptualized and designed the study, performed literature review and drafting, editing, of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Archana Rastogi DNB, MBBS, MD, Professor, Department of Pathology, Institute of Liver & Biliary Sciences (ILBS), D-1, Vasant Kunj, New Delhi 110070, India.
Telephone: +91-11-46300000
Received: June 23, 2018
Peer-review started: June 24, 2018
First decision: July 6, 2018
Revised: July 23, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 21, 2018

Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.

Keywords: Hepatocellular carcinoma, Biomarker, Biopsy, Histopathology, Immunohistochemistry, Targeted therapy, Molecular, Diagnosis, Prognosis

Core tip: Liver biopsy plays important roles in the diagnosis and prognosis of hepatocellular carcinoma. However biopsy related complications and limitations along with advancements in imaging have restricted its role to very limited situations. In recent time, studies on tissue biomarkers, molecular classifications and targeted therapies for hepatocellular carcinoma (HCC) with their clinic-pathologic correlations have highlighted that morphologic variants and subtypes can serve as importance surrogates of molecular signatures, thus renewing the interest in tissue analysis. Tumor biopsy thus is increasingly being recognized as an invaluable tool for the diagnosis, management and prognostication of HCC.