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==Overview==
==Overview==


Biopsy for liver mass may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with liver mass will depend on tumor [[histology]]. Common types of liver tissue biopsy for liver mass, include: channels lined by benign endothelium, fibromuscular hyperplasia, and loss of reticulin scaffold. Common indications for biopsy in liver mass, include: suspected hepatocellular carcinoma, and unspecific imaging findings. The most important contraindication for biopsy in liver mass is suspected liver hemangioma.<ref name="libre"> Hepatocellular carcinoma. Libre Pathology.https://librepathology.org/wiki/Hepatocellular_carcinoma Accessed on March 28, 2016 </ref><ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
Liver biopsy is the gold standard test for the diagnosis of liver mass. Common indications for biopsy in liver mass, include: suspected hepatocellular carcinoma, and unspecific imaging findings. The most important contraindication for biopsy in liver mass is suspected liver hemangioma.<ref name="libre">Hepatocellular carcinoma. Libre Pathology.https://librepathology.org/wiki/Hepatocellular_carcinoma Accessed on March 28, 2016 </ref><ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>


==Biopsy==
==Biopsy==
Biopsy for liver mass may be classified into 2 categories:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
Biopsy is always indicated in patients presenting with liver mass to rule out malignancy. Biopsy findings associated with liver mass will depend on tumor [[histology]]. <ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
*'''Non-surgical biopsy'''
:*Fine needle biopsy
:*Normally used to evaluate some types of liver lesions, such as hepatic adenomas and focal nodular hyperplasia
*'''Surgical'''
:*Surgical resection
* The preferred biopsy technique for malignant liver mass is surgical resection.


*Indications for biopsy in liver mass, include:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
=== Indications ===
:*Suspected hepatocellular carcinoma
:Indications for biopsy in liver mass, include:
:*Suspected hepatic adenoma vs. focal nodular hyperplasia  
:*Suspected hepatocellular carcinoma<ref name="pmid8201212" />
:*Suspected hepatic adenoma 
:*Focal nodular hyperplasia  
:*Unspecific and inconclusive liver mass imaging findings
:*Unspecific and inconclusive liver mass imaging findings


*Contraindications for biopsy in liver mass, include:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
=== Types ===
:* Suspected hemangioma
* Per-cutaneous, ultrasound-guided liver biopsy
:* High risk of seeding of neoplastic cells
* Laparoscopic liver biopsy
:* Intake of anticoagulants
* Transjugular liver biopsy
:* Unstable medical conditions (eg. acute heart failure)
{| class="wikitable"
 
!DIsease
*Complications for for biopsy in liver mass, include:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
!Findings on Biopsy
:*Bleeding
|-
:*Seeding of neoplastic cells
|Focal nodular hyperplasia
 
|Ductular reaction with varied intensity at the junction of the fibrous septa with the hepatocellular component, 
 
|-
==Surgical Biopsy==
|Hepato-cellular carcinoma
 
|Two out of the following three positive stains upon liver biopsy confirm HCC:<ref name="pmid19177576">{{cite journal |vauthors= |title=Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia |journal=Hepatology |volume=49 |issue=2 |pages=658–64 |year=2009 |pmid=19177576 |doi=10.1002/hep.22709 |url=}}</ref><ref name="pmid20400233">{{cite journal |vauthors=Karabork A, Kaygusuz G, Ekinci C |title=The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma |journal=Pathol. Res. Pract. |volume=206 |issue=8 |pages=572–7 |year=2010 |pmid=20400233 |doi=10.1016/j.prp.2010.03.004 |url=}}</ref>
*Surgical excision is the mainstay therapy for malignant liver mass.<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
*[[Glypican 3]]
*Surgical excision is also the primary choice for the definitive diagnosis of malignant liver mass.
*[[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]]
*In liver mass, surgical procedure selection will depend on the histopathological origin and distribution.
*[[Glutamine synthetase]]
|-
|Cirrhosis
|
* Bridging fibrous septa


* Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]].
|}


=== Contraindications ===
*Contraindications for biopsy in liver mass, include:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
**Suspected hemangioma
**Adenomas
**Patients on of anticoagulant therapy
**Unstable medical conditions (eg. acute heart failure)


=== Complications ===
Complications for for biopsy in liver mass, include:<ref name="pmid8201212">{{cite journal |vauthors=Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E |title=The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis |journal=J. Hepatol. |volume=20 |issue=1 |pages=117–21 |year=1994 |pmid=8201212 |doi= |url=}}</ref>
*Bleeding
*Seeding of neoplastic cell<br>
==References==  
==References==  
{{reflist|2}}
{{reflist|2}}

Revision as of 19:16, 31 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Liver biopsy is the gold standard test for the diagnosis of liver mass. Common indications for biopsy in liver mass, include: suspected hepatocellular carcinoma, and unspecific imaging findings. The most important contraindication for biopsy in liver mass is suspected liver hemangioma.[1][2]

Biopsy

Biopsy is always indicated in patients presenting with liver mass to rule out malignancy. Biopsy findings associated with liver mass will depend on tumor histology. [2]

Indications

Indications for biopsy in liver mass, include:
  • Suspected hepatocellular carcinoma[2]
  • Suspected hepatic adenoma
  • Focal nodular hyperplasia
  • Unspecific and inconclusive liver mass imaging findings

Types

  • Per-cutaneous, ultrasound-guided liver biopsy
  • Laparoscopic liver biopsy
  • Transjugular liver biopsy
DIsease Findings on Biopsy
Focal nodular hyperplasia Ductular reaction with varied intensity at the junction of the fibrous septa with the hepatocellular component, 
Hepato-cellular carcinoma Two out of the following three positive stains upon liver biopsy confirm HCC:[3][4]
Cirrhosis
  • Bridging fibrous septa

Contraindications

  • Contraindications for biopsy in liver mass, include:[2]
    • Suspected hemangioma
    • Adenomas
    • Patients on of anticoagulant therapy
    • Unstable medical conditions (eg. acute heart failure)

Complications

Complications for for biopsy in liver mass, include:[2]

  • Bleeding
  • Seeding of neoplastic cell

References

  1. ↑ Hepatocellular carcinoma. Libre Pathology.https://librepathology.org/wiki/Hepatocellular_carcinoma Accessed on March 28, 2016
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E (1994). "The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis". J. Hepatol. 20 (1): 117–21. PMID 8201212.
  3. ↑ "Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia". Hepatology. 49 (2): 658–64. 2009. doi:10.1002/hep.22709. PMID 19177576.
  4. ↑ Karabork A, Kaygusuz G, Ekinci C (2010). "The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma". Pathol. Res. Pract. 206 (8): 572–7. doi:10.1016/j.prp.2010.03.004. PMID 20400233.
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