Published online Oct 28, 2019. doi: 10.3748/wjg.v25.i40.6041
Peer-review started: July 29, 2019
First decision: August 27, 2019
Revised: October 4, 2019
Accepted: October 17, 2019
Article in press: October 17, 2019
Published online: October 28, 2019
The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known cirrhosis. In fact, in the diagnostic algorithm for this tumor, histology is currently relegated to controversial cases. Furthermore, the risk of complications, such as tumor seeding and bleeding, as well as inadequate sampling have further limited the use of liver biopsy for HCC management. However, there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and, as the information content of the tissue sample increases, the advantages of liver biopsy might modify the current risk/benefit ratio. We herein review the role and potentiality of liver biopsy in the diagnosis and management of HCC. As the potentiality of precision medicine comes to the management of HCC, it will be crucial to have rapid pathways to define prognosis, and even treatment, by identifying the patients who could most benefit from target-driven therapies. All of the above reasons suggest that the current role of liver biopsy in the management of HCC needs substantial reconsideration.
Core tip: The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known cirrhosis; indeed, in the diagnostic algorithm for this tumor histology is currently relegated to controversial cases. However, increasing knowledge of the phenotypical and molecular characteristics of HCC is leading to a new scenario in which biopsy may play a decisive role. As the information content of the tissue sample increases, the advantages of liver biopsy may modify the current risk/benefit balance.