Di Tommaso L, Spadaccini M, Donadon M, Personeni N, Elamin A, Aghemo A, Lleo A. Role of liver biopsy in hepatocellular carcinoma. World J Gastroenterol 2019; 25(40): 6041-6052 [PMID: 31686761 DOI: 10.3748/wjg.v25.i40.6041]
Corresponding Author of This Article
Ana Lleo, MD, PhD, Associate Professor, Department of Biomedical Sciences, Humanitas University, Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Via A. Manzoni 56, Rozzano 20089, Italy. ana.lleo@humanitas.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 28, 2019; 25(40): 6041-6052 Published online Oct 28, 2019. doi: 10.3748/wjg.v25.i40.6041
Role of liver biopsy in hepatocellular carcinoma
Luca Di Tommaso, Marco Spadaccini, Matteo Donadon, Nicola Personeni, Abubaker Elamin, Alessio Aghemo, Ana Lleo
Luca Di Tommaso, Abubaker Elamin, Pathology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
Luca Di Tommaso, Marco Spadaccini, Matteo Donadon, Nicola Personeni, Alessio Aghemo, Ana Lleo, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
Matteo Donadon, Division of Hepatobiliary and General Surgery, Department of General Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
Nicola Personeni, Division of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
Alessio Aghemo, Ana Lleo, Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
Author contributions: All authors equally contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.No financial support of interest for the present study.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ana Lleo, MD, PhD, Associate Professor, Department of Biomedical Sciences, Humanitas University, Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Via A. Manzoni 56, Rozzano 20089, Italy. ana.lleo@humanitas.it
Telephone: +39-2-82247231 Fax: +39-2-82242298
Received: July 29, 2019 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 Processing time: 90 Days and 15.7 Hours
Abstract
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.
