title: Assessment of the benefits and risks of percutaneous biopsy before surgical resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  Because of a potential risk of needle tract seeding, the use of ultrasound (US)-guided biopsy for the diagnosis of hepatocellular carcinoma (HCC) is controversial. This study was aimed at determining the usefulness, accuracy and safety of this technique as well as the incidence of needle tract seeding.
  
  
  METHODS
  From 1986 to 1996, 137 patients who underwent resection or transplantation for suspected HCC had US-guided biopsy before surgery. The analysis of the resected liver was compared to the results of biopsy. Patients were assessed with a mean follow up of 38 months.
  
  
  RESULTS
  The diagnosis of HCC was established by biopsy in 122 patients (89%). Thirteen of the 15 patients with negative biopsy were shown to have HCC after surgery. The remaining two patients had non-malignant nodules. Sensitivity and accuracy of US-guided biopsy were 90 and 91%, respectively. Accuracy was significantly influenced by the location of the nodule but not by its size. Needle tract seeding occurred in two patients (1.6%).
  
  
  CONCLUSIONS
  In this series, the incidence of needle tract seeding was less than 2% and no recurrence was observed after local excision. This risk should be balanced with the risk of deciding an aggressive treatment in a patient without malignancy. Patients with negative biopsy should undergo a second biopsy and/or repeated investigations by imaging techniques.
authors.affiliation: Service d'Hépatologie and INSERM U-481, Hĵpital Beaujon, Clichy, Université Paris VII, France.
authors.forename: F
authors.initials: F
authors.lastname: Durand
authors.forename: J M
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
authors.forename: A
authors.initials: A
authors.lastname: Sauvanet
authors.forename: V
authors.initials: V
authors.lastname: Vilgrain
authors.forename: B
authors.initials: B
authors.lastname: Terris
authors.forename: V
authors.initials: V
authors.lastname: Moutardier
authors.forename: O
authors.initials: O
authors.lastname: Farges
authors.forename: D
authors.initials: D
authors.lastname: Valla
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012307:Risk Factors; D014463:Ultrasonography