title: Preoperative tumour biopsy does not affect the oncologic course of patients with transplantable HCC.
abstract: OBJECTIVE
  Preoperative fine-needle aspiration biopsy (PFNAB) allows obtaining reliable hepatocellular carcinoma (HCC) diagnosis before liver transplantation (LT) in doubtful situations, but may result in higher recurrence rates following LT. This study aimed to evaluate whether PFNAB actually jeopardized the outcome of patients with transplantable HCC.
  
  
  METHODS
  From 2002 to 2012, among 309 HCC patients listed for LT, 80 (26%) underwent PFNAB (PFNAB+). Their characteristics, modalities of recurrence, and survivals were retrospectively compared to those of the 229 (74%) patients without PFNAB (PFNAB-).
  
  
  RESULTS
  The two groups (PFNAB+ vs. PFNAB-) were similar in terms of demography, rates of lesions within the Milan criteria (81% vs. 79%, p=0.676), and duration on the waiting list (7.0 vs. 6.9 months, p=0.891). Dropout following tumour progression was similar between both groups (6% vs. 11%, p=0.424). Among the 278 (90%) transplanted patients, pathological analysis revealed that 11 (4%) patients had non-HCC lesions including 10 in PFNAB- patients. Median follow-up was 34 months (12-135) and recurrence after LT was observed in 25 (9%) patients with no difference between both groups (9.3% vs. 8.9%, p=0.904). Parietal recurrence was observed in one PFNAB+ patient and in 2 PFNAB- patients after radiofrequency ablation (p=0.797). On an intention to treat basis, 1-, 3-, and 5-year overall survivals (89%, 69%, and 60% vs. 85%, 67%, and 61%, p=0.601) were not significantly different between PFNAB+ and PFNAB- patients.
  
  
  CONCLUSIONS
  This study supports that preoperative tumour biopsy does not negatively influence the oncologic course of HCC patients eligible for LT. Hence, there is no argument to restrict biopsy in doubtful situations.
authors.affiliation: Department of HPB Surgery, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of HPB Surgery, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of HPB Surgery, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France.
authors.forename: Grazia
authors.initials: G
authors.lastname: Fusco
authors.affiliation: Department of Pathology, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Paradis
authors.affiliation: Department of Hepatology, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Durand
authors.affiliation: Department of HPB Surgery, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France. Electronic address: jacques.belghiti@bjn.aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D011300:Preoperative Care / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: HCC; Liver biopsy; Liver transplantation; Tumour recurrence