title: Lack of tumor seeding of hepatocellular carcinoma after percutaneous needle biopsy using coaxial cutting needle technique.
abstract: OBJECTIVE
  The objective of our study was to determine the incidence of tumor seeding after biopsy of hepatocellular carcinoma (HCC) using a coaxial cutting needle technique. Seeding along the needle track is a dreaded complication of percutaneous biopsy in patients with HCC, particularly in potential liver transplant recipients. Reported seeding rates range from 0.6% to 5.1% using various biopsy techniques. To our knowledge, the rate of seeding using a coaxial cutting needle technique has not been reported.
  
  
  METHODS
  Retrospective review identified 128 patients with imaging-guided percutaneous liver biopsies positive for HCC. A coaxial cutting needle technique was uniformly used with a 17-gauge introducer and 18-gauge biopsy needle. Radiology and clinical reports were reviewed, and findings at clinical and imaging follow-up were assessed.
  
  
  RESULTS
  During the 6-year study period, 1,012 liver mass biopsies were performed, with 128 positive for HCC (100 men and 28 women; average age, 58.4 years). One hundred one patients had more than 30 days of clinical or imaging follow-up (or both) after biopsy (mean, 410 days; range, 33-1,989 days) and constituted the study population. The remaining 27 were excluded because of inadequate follow-up. No suspected or confirmed tumor seeding on imaging, physical examination, or laparotomy was identified.
  
  
  CONCLUSIONS
  We found no tumor seeding after percutaneous biopsy of HCC using a coaxial cutting needle technique. This rate, 0%, is lower than those reported with other techniques. The use of a needle introducer that remains in position during multiple cutting needle passes protects normal tissue along the track and may reduce seeding. This has particular importance for patients with stage I-II HCC, for whom liver transplantation may be curative.
authors.affiliation: Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI 48019-0030, USA. katematuren@yahoo.com
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
authors.forename: Hanh V
authors.initials: HV
authors.lastname: Nghiem
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
authors.forename: Hero K
authors.initials: HK
authors.lastname: Hussain
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Higgins
authors.forename: Giovanna A
authors.initials: GA
authors.lastname: Fox
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Francis
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D009366:Neoplasm Seeding