Liver mass diagnostic study of choice: Difference between revisions
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==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]] | ||
{| class="wikitable" | {| class="wikitable" | ||
!DIsease | !DIsease | ||
Line 24: | Line 24: | ||
|- | |- | ||
|Focal nodular hyperplasia | |Focal nodular hyperplasia | ||
| | | | ||
* Fibrous septa between hepatocytes which form a stellate scar | |||
* Chronic cholestasis | |||
* Prominent arteries | |||
|- | |- | ||
| | |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> | |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]] | ||
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* Bridging fibrous septa | * Bridging fibrous septa | ||
* Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]] | * Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]] | ||
|} | |} | ||
=== 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}} | {{reflist|2}} |
Revision as of 15:07, 29 November 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]
- 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:[3][4] |
Cirrhosis |
|
Contraindications
- Contraindications for biopsy in liver mass, include:[2]
- 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:[2]
- Bleeding
- Seeding of neoplastic cells
References
- ↑ Hepatocellular carcinoma. Libre Pathology.https://librepathology.org/wiki/Hepatocellular_carcinoma Accessed on March 28, 2016
- ↑ 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.
- ↑ "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.