Clinical

US-guided biopsy diagnoses early cancer in cirrhosis patients

Last Updated: 2004-09-10 11:22:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Fine needle biopsy guided by ultrasound is effective in identifying early hepatocellular carcinoma in patients with cirrhotic livers, Italian researchers report in the September issue of Gut.

"Ultrasound allows detection of very small focal liver lesions," lead investigator Dr. E. Caturelli, of Ospedale Belcolle, Vierbo, told Reuters Health. "Most of such lesions, as easily proved by aimed fine-needle biopsy, are neoplastic or preneoplastic, and they are susceptible to prompt therapy."

Dr. Caturelli and colleagues analyzed data from 246 new nodular lesions smaller than 20 mm, and 48 lesions smaller than 10 mm, which were detected by ultrasound during screening in 4375 patients with hepatic cirrhosis.

In 274 patients, alpha-fetoprotein (AFP) levels did not allow diagnosis of liver cancer, and ultrasound-guided fine needle biopsy was performed.

Altogether, 258 (87.6%) of lesions proved to be hepatocellular carcinoma, which included 33 (68.7%) of the lesions smaller than or equal to10 mm.

Typing accuracy for all lesions was 89.4%. For the smaller lesions, it was 88.6%.

In an accompanying editorial, Drs. J. Scholmerich and D. Schacherer of the University of Regensburg, Germany note that the study "provides long sought after and important information on the possible efficacy of US guided biopsy of hepatocellular carcinoma in experienced hands and will probably define the gold standard of quality of this procedure."

However, they add that it does answer the question of whether and in whom biopsy should be performed. This, they say, "remains to some extent a bedside decision."

Gut 2004;53:1224-1226,1356-1362.