Suspicious liver nodule in chronic liver disease: Usefulness of a second biopsy
V. Cartier
(1)
,
A. Crouan
(2)
,
M. Esvan
(3, 4)
,
F. Oberti
(1)
,
S. Michalak
(1)
,
B. Gallix
,
O. Seror
(5)
,
A. Paisant
(6)
,
V. Vilgrain
(7)
,
C. Aubé
(8, 1)
,
R. Anty
(9)
,
I. Archambeaud
(10)
,
G. Baudin
(9)
,
V. Brun
(6)
,
P. Chevallier
(9)
,
M. Cuilleron
(11)
,
J. Dumortie
(12)
,
C. Duvoux
(13)
,
L. Estivalet
(14)
,
E. Frampas
(10)
,
Y. Gandon
(6)
,
A. Guillygomarc’h
(15)
,
B. Guiu
(16)
,
J. Lebigot
(1)
,
V. Le Pennec
(17)
,
A. Luciani
(13)
,
A. Minello
(1, 2)
,
I. Ollivier-Hourmand
(1, 4)
,
F. Pilleul
(1, 3)
,
B. Patouillard
(1)
,
C. Sylvain
(1)
,
J.P. Tasu
(1)
1
CHU Angers -
Centre Hospitalier Universitaire d'Angers
2 CHU Gabriel Montpied [Clermont-Ferrand]
3 CIC 1418 - CIC - HEGP
4 CIC AP-HP (hegp Ex-Broussais)/inserm
5 Hôpital Jean Verdier [AP-HP]
6 Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes]
7 Hôpital Beaujon [AP-HP]
8 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
9 Hôpital l'Archet
10 CHU Nantes - Centre hospitalier universitaire de Nantes
11 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
12 Hôpital Edouard Herriot [CHU - HCL]
13 CHU Henri Mondor [Créteil]
14 Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon)
15 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital
16 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
17 Service d'Imagerie Diagnostique et de Radiologie Thérapeutique [CHU Caen]
2 CHU Gabriel Montpied [Clermont-Ferrand]
3 CIC 1418 - CIC - HEGP
4 CIC AP-HP (hegp Ex-Broussais)/inserm
5 Hôpital Jean Verdier [AP-HP]
6 Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes]
7 Hôpital Beaujon [AP-HP]
8 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
9 Hôpital l'Archet
10 CHU Nantes - Centre hospitalier universitaire de Nantes
11 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
12 Hôpital Edouard Herriot [CHU - HCL]
13 CHU Henri Mondor [Créteil]
14 Service de radiologie et d'Imagerie médicale diagnostique et thérapeutique (CHU de Dijon)
15 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital
16 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
17 Service d'Imagerie Diagnostique et de Radiologie Thérapeutique [CHU Caen]
B. Gallix
- Fonction : Auteur
V. Brun
- Fonction : Collaborateur
M. Cuilleron
- Fonction : Collaborateur
L. Estivalet
- Fonction : Collaborateur
Y. Gandon
- Fonction : Collaborateur
A. Guillygomarc’h
- Fonction : Collaborateur
V. Le Pennec
- Fonction : Collaborateur
A. Minello
- Fonction : Collaborateur
I. Ollivier-Hourmand
- Fonction : Collaborateur
F. Pilleul
- Fonction : Collaborateur
- PersonId : 170728
- IdHAL : frank-pilleul
- ORCID : 0000-0002-9643-5230
- IdRef : 059516860
Résumé
Purpose
To assess the usefulness of a second biopsy when the first one was inconclusive in patients with a liver nodule found during the follow-up for chronic liver disease.
Materials and methods
Among 381 patients (544 nodules) included in a prospective study designed to evaluate the accuracy of imaging for the diagnosis of small hepatocellular carcinoma (HCC) in chronic liver disease, 254 nodules were biopsied. The following histological results were considered as conclusive: HCC, dysplastic or regenerative nodule, and other identified tumors (benign or malignant). For nodules with inconclusive results (e.g. fibrosis or no definite focal lesion), a second biopsy was suggested, but was not mandatory.
Results
A total of 242 patients (194 men, 48 women; mean age, 61.9 ± 9.5 [SD]; range: 40.2–89.0 years) with 254 nodules underwent a first biopsy. Mean nodule diameter was 19.2 ± 5.4 mm (range: 10–33 mm). The first biopsy was conclusive in 189/254 nodules (74.4%): 157 HCCs (83.1%), 11 regenerative nodules (5.8%), 10 dysplastic nodules (5.3%), 3 cholangiocarcinomas (1.6%), and 8 other tumors (4.2%). Among the 65 nodules for which the first biopsy was inconclusive, a second biopsy was performed for 17 nodules in 16 patients within 6 months of the first one. It was conclusive in 13/17 nodules (76.5%): 10 HCCs (76.9%), 2 dysplastic nodules (15.4%), and 1 other tumor (7.7%). In 4/17 nodules (23.5%), no definitive diagnosis could be provided.
Conclusion
The diagnostic yield of a second biopsy of a suspicious lesion suggestive of HCC in chronic liver disease is not decreased compared to the first one. Repeated biopsy after a first negative one could be an alternative option to the follow-up of patients with chronic liver disease.