Biopsy and Puncture Track Metastasis
In their review article, the authors provide an overview of the indications for liver biopsy. They discuss biopsy of focal solitary and multiple hepatic lesions and mention the problem of biopsy-track metastases (1). The relevant data are heterogeneous, as the authors themselves pointed out.
This complication has to be considered and included early on in the clinical process of making a diagnosis, especially in patients in whom surgical-curative treatment is an option (2–4). It seems important to refer such patients early on—that is, before the planned biopsy—to a multidisciplinary team for further investigation, such as is common practice in so called tumor boards (2).
The authors mention that in a 2008 meta-analysis, biopsy-track metastases did not affect patients’ survival. The literature (for example, a 2009 review) indicates that, in addition to repeated treatment, the biopsy of malignant hepatic lesions can also have a negative effect on patients’ survival (2). It was also mentioned that biopsy does not necessarily confer a diagnostic advantage compared with the combination of non-invasive imaging procedures and measuring of tumor markers.
A retrospective study found that the possibility of biopsy-track metastases also existed in patients with well differentiated primary tumors (4). This may indicate that metastasis after percutaneous biopsy is independent of the degree of differentiation of the primary malignancy.
Laparoscopic biopsy is an alternative option to avoid this complication, and it offers the twin advantages of being able to assess intraperitoneal organs and structures and to immediately initiate an intervention if complications occur during the tissue removal.
Dr. med. Sammy A. Baierlein
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Tannapfel A, Dienes HP, Lohse AW: The indications for liver biopsy. Dtsch Arztebl Int 2012; 109(27–28): 477–83. VOLLTEXT|
|2.||Cresswell AB, Welsh FK, Rees M: A diagnostic paradigm for resectable liver lesions: to biopsy or not to biopsy? HPB (Oxford). 2009; 11: 533–40. CrossRef MEDLINE PubMed Central|
|3.||Takamori R, Wong LL, Dang C, Wong L: Needle-tract implantation from hepatocellular cancer: is needle biopsy of the liver always necessary? Liver Transpl 2000; 6: 67–72. MEDLINE|
|4.||Kosugi C, Furuse J, Ishii H, et al.: Needle tract implantation of hepatocellular carcinoma and pancreatic carcinoma after ultrasound-guided percutaneous puncture: clinical and pathologic characteristics and the treatment of needle tract implantation. World J Surg 2004; 28: 29–32. Epub 2003 Dec 5. CrossRef MEDLINE|