Section of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua, Italy.
Section of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua, Italy.
Dig Liver Dis. 2018 Jul;50(7):640-646. doi: 10.1016/j.dld.2018.03.014. Epub 2018 Mar 20.
The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has changed over time. The diagnostic algorithm for this tumor is nowadays mainly based on radiological imaging, relegating histology to controversial cases, in which imaging techniques cannot establish a clear-cut diagnosis. This most commonly happens in small lesions, where biopsies frequently become mandatory, or in larger hypovascularized lesions. In this case however, the histological examination may not be reliable enough to grade the lesion, as different cell clones, deriving from sequential mutations, can originate heterogeneous cell populations. The risk of complications of liver biopsy, such as tumor seeding and intra-abdominal bleeding, needs to be reconsidered in light of new scientific evidence and of the technical improvements that have been introduced. Furthermore, increasing knowledge of the immunohistochemical and molecular characteristics of hepatocellular carcinoma opens a new scenario in which biopsy may play a decisive role in defining prognosis, and even treatment, by identifying the patient populations who could most benefit from target-driven hepatocellular carcinoma treatments, and therefore improving the success rate of experimental therapies. All the above reasons suggest that, overall, the role of liver biopsy in the management of HCC needs a reappraisal.
肝活检在肝细胞癌（HCC）诊断中的作用随时间而变化。目前，该肿瘤的诊断算法主要基于影像学，将组织学留作影像学无法明确诊断的有争议的病例。这种情况最常发生在小病变中，活检通常是必需的，或者在较大的乏血管病变中。然而，在这种情况下，组织学检查可能不足以对病变进行分级，因为源自连续突变的不同细胞克隆可以产生异质细胞群体。鉴于新的科学证据和引入的技术改进，需要重新考虑肝活检的并发症风险，如肿瘤播散和腹腔内出血。此外，对肝细胞癌的免疫组织化学和分子特征的了解不断增加，为活检在通过确定最能从靶向肝细胞癌治疗中受益的患者人群来确定预后，甚至治疗方面提供了新的前景，从而提高实验治疗的成功率。所有这些原因都表明，总体而言，肝活检在 HCC 管理中的作用需要重新评估。
