title: Does preoperative fine needle aspiration-biopsy produce tumor recurrence in patients following liver transplantation for hepatocellular carcinoma?
abstract: BACKGROUND
  Liver transplantation (OLT) has been advocated for patients with carcinoma hepatocellular (HCC). A preoperative biopsy (fine needle aspiration biopsy) [FNA] facilitates preoperative diagnosis of adverse pathological factors: vascular invasion or histologicalic differentiation. But a biopsy may cause abdominal dissemination and be related to a higher incidence of recurrence.
  
  
  METHODS
  From April 1986 to December 2003, we performed 95 OLT for HCC. We divided them in two groups: group A without FNA-biopsy (67.9%) and group B with FNA-biopsy (32.1%).
  
  
  RESULTS
  We obtained the diagnosis of HCC in only 15 patients (57.6%). In two patients an OLT was avoided due to the presence of abdominal dissemination at the time of transplant. Recurrence incidence was higher among group B patients (5.9% vs 31.8%; P = .003) due to extrahepatic recurrence (2% vs 27.3%; P = .003). No differences were observed in morbidity or mortality. The two groups were homogeneous in epidemiological and pathological variables except: sex distribution, Child status, AFP level, tumor size, and pTNM stage. If we compare recurrence rates in the two groups attending to these nonhomogeneous variables, it was significantly higher among patients with tumors larger than 3 cm, pTNM I-III stage, Child B-C, AFP >200 ng/mL, and males or females.
  
  
  CONCLUSIONS
  Preoperative liver biopsy is associated with a larger incidence of tumor recurrence, so we believe that it is not necessary prior to an OLT for HCC.
authors.affiliation: General, Digestive and Abdominal Organs Transplantation Surgical Department, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: B Pérez
authors.initials: BP
authors.lastname: Saborido
authors.forename: J C Menéu
authors.initials: JC
authors.lastname: Díaz
authors.forename: S Jiménez
authors.initials: SJ
authors.lastname: de Los Galanes
authors.forename: C Loinaz
authors.initials: CL
authors.lastname: Segurola
authors.forename: M Abradelo
authors.initials: MA
authors.lastname: de Usera
authors.forename: M Donat
authors.initials: MD
authors.lastname: Garrido
authors.forename: A Moreno
authors.initials: AM
authors.lastname: Elola-Olaso
authors.forename: R Gómez
authors.initials: RG
authors.lastname: Sánz
authors.forename: C Jiménez
authors.initials: CJ
authors.lastname: Romero
authors.forename: I
authors.initials: I
authors.lastname: Garcia García
authors.forename: E Moreno
authors.initials: EM
authors.lastname: González
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome