Copyright ©The Author(s) 2018.
World J Gastroenterol. Sep 21, 2018; 24(35): 4000-4013
Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4000
Table 1 Role of tumour tissue analysis in hepatocellular carcinoma
Distinguishing HCC from metastasisPrognostic histomorpholic parameters-tumour grade, vessel invasion, pTNM stage
Distinguishing benign/preneoplastic lesions from HCCIdentification of Histological variants of prognostic importance
Diagnosis confirmation of small HCCTissue biomarkers-for prognostication
Diagnosis of liver nodules in non-cirrhotic backgroundTissue biomarkers-for assessing presence of therapeutic targets and drug development
Diagnosis of atypical variants of HCC, which have atypical Imaging findingsHistologic surrogates of clinically relevant molecular signatures-for predicting prognosis
Combined HCC-CCHistologic surrogates of clinically relevant molecular signatures-as predictors of potential responders for targeted therapies
Diagnosis confirmation of HCC in phase III trials of new drugs
Table 2 Based on the evidence from published literature, algorithm based on the role of tissue diagnosis is inserted
MandatoryPotentially necessary/helpfulUnwarranted
Lesion in a cirrhotic patient that lacks typical imaging characteristicsWell-differentiated HCCHCC, if typical features are present on dynamic imaging technique
All nodules developing in the non-cirrhotic background< 2 cm sized HCC, due to hypovascularity in small HCC and lack of typical imaging findingsAFP levels very high in the absence of other known causative tumours
Combined hepato-cholangiocarcinomaPredictors of prognosisCurative resection possible due to risk of needle tract seeding, if biopsied
Atypical variants of HCCTeaching and biobanking
Identifying stem cell phenotypesDistinguishing HCC from regenerative nodule, dysplastic nodule, hepatic adenoma, FNH
Phase III trials of novel drugsMorphologic surrogates of molecular signatures
Tissue biomarker development and studiesSurrogate biomarkers of MVI in liver biopsy