Q:

Which of the following statement(s) is/are true concerning biopsy techniques for hepatic masses?

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Which of the following statement(s) is/are true concerning biopsy techniques for hepatic masses?


  1. A fine needle aspiration (FNA for cytology is contraindicated for patients with hypervascular masses)
  2. Percutaneous biopsy should be performed only if results may obviate the need for exploratory laparotomy
  3. Needle track seeding of tumor is not a risk associated with percutaneous biopsy
  4. Laparoscopy and biopsy play little role in the management of liver lesions

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b. Percutaneous biopsy should be performed only if results may obviate the need for exploratory laparotomy

Biopsy of a liver mass can be done percutaneously (with or without CT or ultrasound guidance), laparoscopically, or at laparotomy. The biopsy may be done for cytology only (FNA) or for histology (larger-core biopsy). Guided FNA has an overall sensitivity of 77% to 94% and may allow a distinction between primary and secondary malignancy. The risks associated with needle biopsy include bleeding, infection, needle track seeding of tumor, and sampling error. Hypervascular masses, coagulopathy, and ascites are contraindications to percutaneous core biopsy, however, FNA biopsy is generally considered safe under these circumstances. In evaluation of any liver mass, percutaneous biopsy should be performed only if it can reasonably be expected to obviate the need for exploratory laparotomy. Biopsy of suspected primary metastatic malignancy with clinical indications of unresectability may spare the patient an unnecessary laparotomy. Laparoscopy with biopsy may also be used to evaluate liver masses and to possibly avoid laparotomy in patients considered to be borderline resectable.

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