title: Should a radiological diagnosis of hepatocellular carcinoma be routinely confirmed by a biopsy? No.
abstract: Modern multiphase diagnostic imaging allows diagnosis of hepatocellular carcinoma with high specificity in a large proportion of cases. Additional aspects of tumor biology also can be evaluated noninvasively through observation of tumor behavior (growth rate, satellites, vascular invasion) and other indicators of tumor biology (avid uptake of fluorodeoxyglucose, high circulating levels of tumor markers such as alphafetoprotein). Routinely requiring biopsy confirmation for diagnosis of HCC exposes many patients to unnecessary risk, may delay diagnosis, and in some cases leads to withholding of potentially beneficial treatment. Biopsy for assessment of tumor molecular markers is promising but remains investigational. When diagnosis of HCC is clinically evident by imaging criteria, tumor biopsy should not be required prior to initiating treatment.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA 23249, USA. Dmheuman@vcu.edu
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Heuman
authors.forename: HoChong S
authors.initials: HS
authors.lastname: Gilles
authors.forename: Cynthia
authors.initials: C
authors.lastname: Solomon
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography