Direct comparison of biopsy techniques for hepatic malignancies

• Published in: Clinical and molecular hepatology Vol. 27; no. 2; pp. 305 - 312
• Main Authors: Huang, Shang-Chin, Liang, Ja-Der, Hsu, Shih-Jer, Hong, Tzu-Chan, Yang, Hung-Chih, Kao, Jia-Horng
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01.04.2021; The Korean Association for the Study of the Liver; 대한간학회
• Subjects: Biopsy; Cellular biology; Cholangiocarcinoma; cytology; histology; Liver cancer; Medical records; Metastasis; Original; Patients; Regression analysis; Tumors; Ultrasonic imaging; ultrasonography; 내과학; Liver cancer; Histology; Biopsy; Cytology; Ultrasonography
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2020.0301

The core needle biopsy (CNB), fine needle aspiration cytology (FNAC) and touch imprint cytology (TIC) are commonly used tools for the diagnosis of hepatic malignancies. However, little is known about the benefits and criteria for selecting appropriate technique among them in clinical practice. We aimed to compare the sensitivity of ultrasound-guided CNB, FNAC, TIC as well as combinations for the diagnosis of hepatic malignancies, and to determine the factors associated with better sensitivity in each technique. From January 2018 to December 2019, a total of 634 consecutive patients who received ultrasound-guided liver biopsies at the National Taiwan University Hospital was collected, of whom 235 with confirmed malignant hepatic lesions receiving CNB, FNAC and TIC simultaneously were enrolled for analysis. The clinical and procedural data were compared. The sensitivity of CNB, FNAC and TIC for the diagnosis of malignant hepatic lesions were 93.6%, 71.9%, and 85.1%, respectively. Add-on use of FNAC or TIC to CNB provided additional sensitivity of 2.1% and 0.4%, respectively. FNAC exhibited a significantly higher diagnostic rate in the metastatic cancers (P=0.011), hyperechoic lesions on ultrasound (P=0.028), and those with depth less than 4.5 cm from the site of needle insertion (P=0.036). The sensitivity of CNB is superior to that of FNAC and TIC for the diagnosis of hepatic malignancies. Nevertheless, for shallow (depth <4.5 cm) and hyperechoic lesions not typical for primary liver cancers, FNAC alone provides excellent sensitivity.