Liver mass diagnostic study of choice: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Liver mass}} | {{Liver mass}} | ||
{{CMG}}{{AE}}{{MV}} | {{CMG}}; {{AE}}{{MV}} | ||
==Overview== | ==Overview== | ||
[[Liver biopsy]] is the gold standard test for the diagnosis of liver mass. Common indications for biopsy in liver mass includes suspected [[hepatocellular carcinoma]], and unspecific imaging findings. The most important contraindication for [[biopsy]] in liver mass is suspected liver [[hemangioma]]. | |||
Liver | |||
==Biopsy== | ==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]]. <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> | ||
=== Indications === | === Indications === | ||
Indications for [[biopsy]] in liver mass, include: | |||
:*Suspected hepatocellular carcinoma<ref name="pmid8201212" /> | :*Suspected [[hepatocellular carcinoma]]<ref name="pmid8201212" /> | ||
:*Unspecific and inconclusive liver mass imaging findings | :*Unspecific and inconclusive liver mass imaging findings | ||
=== Types === | === Types === | ||
* | * Percutaneous, ultrasound-guided [[liver biopsy]] | ||
* Laparoscopic liver biopsy | * [[Laparoscopic surgery|Laparoscopic]] [[liver biopsy]] | ||
* Transjugular liver biopsy | * Transjugular [[liver biopsy]] | ||
{| | {| | ||
! | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Findings on Biopsy | |||
|- | |- | ||
|Focal nodular hyperplasia | ! align="center" style="background:#DCDCDC;" + |Focal nodular hyperplasia | ||
| | | align="left" style="background:#F5F5F5;" + | | ||
* Fibrous septa between [[hepatocytes]] which form a stellate scar | |||
* Chronic [[cholestasis]] | |||
* Prominent arteries | |||
|- | |- | ||
| | ! align="center" style="background:#DCDCDC;" + |Hepatocellular 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> | | align="left" style="background:#F5F5F5;" + |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> | ||
*[[Glypican 3]] | *[[Glypican 3]] | ||
*[[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]] | *[[Heat shock protein 70 (Hsp70) internal ribosome entry site (IRES)|Heat shock protein 70]] | ||
*[[Glutamine synthetase]] | *[[Glutamine synthetase]] | ||
|- | |- | ||
|Cirrhosis | ! align="center" style="background:#DCDCDC;" + |Cirrhosis | ||
| | | align="left" style="background:#F5F5F5;" + | | ||
* Bridging fibrous septa | * Bridging fibrous septa | ||
* Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and senescent [[Hepatocyte|hepatocytes]] | |||
* Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and | |||
|} | |} | ||
=== Contraindications === | === 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> | *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]] | **Suspected [[hemangioma]] | ||
**Adenomas | **[[Adenoma|Adenomas]] | ||
**Patients on of [[anticoagulant]] therapy | **Patients on of [[anticoagulant]] therapy | ||
**Unstable medical conditions (e.g. [[Congestive heart failure|acute heart failure]]) | **Unstable medical conditions (e.g. [[Congestive heart failure|acute heart failure]]) | ||
=== Complications === | === 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> | 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 | *[[Bleeding]] | ||
*Seeding of neoplastic | *Seeding of neoplastic cells<br> | ||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category: | [[Category:Oncology]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 22:31, 29 July 2020
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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 includes suspected hepatocellular carcinoma, and unspecific imaging findings. The most important contraindication for biopsy in liver mass is suspected liver hemangioma.
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. [1]
Indications
Indications for biopsy in liver mass, include:
- Suspected hepatocellular carcinoma[1]
- Unspecific and inconclusive liver mass imaging findings
Types
- Percutaneous, ultrasound-guided liver biopsy
- Laparoscopic liver biopsy
- Transjugular liver biopsy
| Disease | Findings on Biopsy |
|---|---|
| Focal nodular hyperplasia |
|
| Hepatocellular carcinoma | Two out of the following three positive stains upon liver biopsy confirm HCC:[2][3] |
| Cirrhosis |
|
Contraindications
- Contraindications for biopsy in liver mass, include:[1]
- Suspected hemangioma
- Adenomas
- Patients on of anticoagulant therapy
- Unstable medical conditions (e.g. acute heart failure)
Complications
Complications for for biopsy in liver mass, include:[1]
- Bleeding
- Seeding of neoplastic cells
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ "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.
- ↑ 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.