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Original Research |
1 Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI
48019-0030.
2 Present address: Department of Radiology, Stanford University Medical Center,
300 Pasteur Dr., Room H1307, Stanford, CA 94305-5227.
3 Present address: Department of Radiology, Beaumont Hospital, Royal Oak, MI
48073.
4 Department of Internal Medicine, Division of Gastroenterology, University of
Michigan Hospitals, Ann Arbor, MI 48019-0030.
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.
MATERIALS AND 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.
CONCLUSION. 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.
Keywords: abdominal imaging • biopsy • hepatocellular carcinoma • liver cancer • liver disease
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