Our Summary

This research paper discusses the challenges of identifying and managing liver lesions, which are abnormal growths in the liver. Imaging techniques such as CT scans and MRI scans are most commonly used to identify these lesions. In most cases, these scans, along with patient information and biochemistry tests, can help make a diagnosis.

Other techniques such as contrast-enhanced ultrasound and hepatobiliary specific contrast agents can sometimes be helpful. However, in patients with liver cirrhosis (a disease that causes scarring and damage to the liver), it can be more difficult because there can be a range of benign (non-cancerous), dysplastic (abnormal, but not cancerous) and malignant (cancerous) nodules.

The report of the lesion should include all necessary information for staging, which is a way of determining how far a disease has progressed. Guidelines for these reports have been published and should be considered. The decision to proceed with a biopsy (removing a small piece of tissue for examination) should only be made after a team of medical professionals have reviewed the case. If a biopsy is needed, a fine needle aspiration (removing cells using a thin needle) is usually enough, but in some cases a core needle biopsy (removing a small piece of tissue using a larger needle) may be required.

FAQs

  1. What are the primary modalities for liver lesion characterization?
  2. What additional imaging modalities can be used to diagnose liver lesions?
  3. When should a decision to proceed to liver biopsy be made?

Doctor’s Tip

A helpful tip a doctor might tell a patient about liver biopsy is to make sure to follow any pre-procedure instructions provided, such as fasting before the procedure. It is also important to inform the doctor of any medications, allergies, or medical conditions the patient may have. After the biopsy, it is important to follow any post-procedure care instructions and to contact the doctor if there are any signs of infection or other complications. It is also important to follow up with the doctor for the results and any further treatment recommendations.

Suitable For

Patients who are typically recommended for liver biopsy include those with:

  1. Suspicion of liver cancer, including hepatocellular carcinoma or cholangiocarcinoma
  2. Evaluation of liver lesions that are atypical or indeterminate on imaging studies
  3. Monitoring of liver disease progression or treatment response in patients with chronic liver conditions such as cirrhosis or hepatitis
  4. Diagnosis of specific liver diseases such as autoimmune hepatitis, primary biliary cholangitis, or non-alcoholic fatty liver disease
  5. Assessment of liver transplant candidates for evaluation of liver function and potential rejection
  6. Investigation of unexplained liver abnormalities or elevated liver enzymes
  7. Evaluation of potential liver metastases from other primary cancers.

It is important for a multidisciplinary team, including radiologists, hepatologists, and surgeons, to review each case and determine the necessity of a liver biopsy based on the patient’s clinical presentation, imaging findings, and overall medical history.

Timeline

Before liver biopsy:

  1. Patient presents with symptoms or abnormal liver function tests.
  2. Imaging modalities such as contrast-enhanced computed tomography or magnetic resonance imaging are performed to detect liver lesions.
  3. Lesions are characterized based on imaging findings, patient demographics, and biochemistry.
  4. Decision is made on whether biopsy is necessary based on the imaging findings and multidisciplinary review.

After liver biopsy:

  1. Patient undergoes fine needle aspiration or core needle biopsy to obtain tissue sample.
  2. Biopsy sample is analyzed to confirm the diagnosis of the liver lesion.
  3. Treatment plan is developed based on the biopsy results.
  4. Patient is monitored for any complications from the biopsy procedure.
  5. Follow-up imaging may be performed to assess response to treatment and monitor for any recurrence of the liver lesion.

What to Ask Your Doctor

  1. Why do I need a liver biopsy?
  2. What information will the liver biopsy provide?
  3. What are the risks and potential complications of a liver biopsy?
  4. How should I prepare for the liver biopsy procedure?
  5. Will I need to stop taking any medications before the liver biopsy?
  6. How long will the liver biopsy procedure take?
  7. What can I expect during and after the liver biopsy procedure?
  8. When will I receive the results of the liver biopsy?
  9. What are the potential diagnoses that could be determined from the liver biopsy?
  10. What are the potential treatment options based on the results of the liver biopsy?

Reference

Authors: Pang EH, Harris AC, Chang SD. Journal: Can Assoc Radiol J. 2016 May;67(2):130-48. doi: 10.1016/j.carj.2015.07.005. Epub 2015 Dec 17. PMID: 26702758