Resection of hepatocellular carcinoma without preoperative tumor biopsy

Objective To evaluate the need for a preoperative tumor biopsy of liver lesions suspi cious for hepatocellular carcinoma (HCC). Summary Background Data With advances in liver imaging, the results of recent studies have, suggest ed a very high accuracy of preoperative evaluation of liver masses suspicio us of HCC, making preoperative tumor biopsy unnecessary. Methods A retrospective analysis was conducted of all liver resections for HCC at t he Toronto General and Mt. Sinai Hospitals, Toronto, between October 1994 a nd December 1998. Results Sixty patients underwent 65 liver resections without a preoperative liver b iopsy. The median age was 61 years. Sixty percent of the patients had cirrh osis and 38.5% had noncirrhotic chronic hepatitis. HCC was confirmed histol ogically in the surgical specimen in 63 of the 65 cases (96.9%). Both patie nts without HCO had a significant risk factor for HCO (chronic hepatitis C and alcohol in one and chronic hepatitis B and previous resection for HCC I n the other). The lesions were 2 cm and 2.7 cm in diameter, and the alpha-f etoprotein level was low (<5 and 22 ng/mL, respectively). In such patients, with tumor 3 cm or smaller and an alpha-fetoprotein level less than 100 ng /mL (10 patients), the false-positive rate for the preoperative diagnosis w as 2/10 (20%). Conclusions Preoperative diagnosis of HOC was highly accurate in lesions larger than 3 cm. Tumor biopsy is unnecessary in these patients. However, in a subgroup o f patients with lesions less than 3 cm, particularly those with alpha-fetop rotein levels less than 100 ng/mL, there Is a higher false-positive diagnos tic rate, and tumor biopsy should be considered.