Does preoperative fine needle aspiration-biopsy produce tumor recurrence in patients following liver transplantation for hepatocellular carcinoma?
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.
Saborido
B Pérez
BP
General, Digestive and Abdominal Organs Transplantation Surgical Department, 12 de Octubre Hospital, Madrid, Spain.
Díaz
J C Menéu
JC
de Los Galanes
S Jiménez
SJ
Segurola
C Loinaz
CL
de Usera
M Abradelo
MA
Garrido
M Donat
MD
Elola-Olaso
A Moreno
AM
Sánz
R Gómez
RG
Romero
C Jiménez
CJ
Garcia García
I
I
González
E Moreno
EM
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