Needle-tract implantation from hepatocellular cancer: Is needle biopsy of the liver always necessary?

Percutaneous needle biopsies are frequently used to evaluate focal lesions of the liver. Needle-tract implantation of hepatocellular cancer has been d escribed in case reports, but the true risk for this problem has not been c learly defined. We retrospectively reviewed 91 cases of hepatocellular canc er during a 4-year period from 1994 to 1997. Data on diagnostic studies, th erapy and outcome were noted. Of 91 patients with hepatocellular cancer, 59 patients underwent percutaneous needle biopsy as part of their diagnostic workup for a liver mass. Three patients (5.1%) were identified with needle- tract implantation of tumor. Two patients required en bloc chest wall resec tions for implantation of hepatocellular cancer in the soft tissues and rib area. The third patient, who also received percutaneous ethanol injection of his tumor, required a thoracotomy and lung resection for implanted hepat ocellular cancer. Percutaneous needle biopsy of suspicious hepatic lesions should not be performed indiscriminately because there is a significant ris k for needle-tract implantation. These biopsies should be reserved for thos e lesions in which no definitive surgical intervention is planned and patho logical confirmation is necessary for a nonsurgical therapy. Copyright (C) 2000 by the American Association for the Study of Liver Diseases.