Abstract

Background and aim: Liver biopsy is not routinely recommended for the diagnosis of hepatocellular carcinoma (HCC). Identification of characteristic imaging findings is usually sufficient for diagnosis and biopsy is recommended for a subset of patients with indeterminate lesions based on imaging or clinical characteristics. The study aim was to determine real-world utilization and accuracy of liver biopsy in patients ultimately diagnosed with HCC in a community setting during an era when liver biopsy was commonly utilized. Methods: In this retrospective study, 388 consecutive patients diagnosed with HCC between 1/2005 and 12/2006 in a Northern California managed care population were evaluated to determine if they underwent liver biopsy during diagnostic workup for HCC. We evaluated predictors of biopsy and performed descriptive statistics, univariate and multivariate logistic regression. Results: Liver biopsy was performed in 244 patients (62.9%). Inconclusive or false negative biopsies occurred in 47 patients (19.3%). Of those biopsied, 206 (84.4%) underwent single biopsy, 33 (13.5%) underwent 2 biopsies, and 5 (2.1%) underwent > 2 biopsies. Tumors < 2 cm accounted for 8.2% of biopsies. Absence of cirrhosis increased odds of biopsy (Odds ratio [OR] 3.9, 95% confidence interval [CI] 1.7-8.6) whereas alpha-fetoprotein > 500 ng/mL decreased odds of biopsy (OR 0.18, 95% CI 0.09-0.35). Cancer stage, number of lesions, lesion size, and Model for End-Stage Liver Disease score were not statistically significant predictors of undergoing biopsy. Conclusions: False negative and inconclusive liver biopsies occur in one-fifth of patients who undergo diagnostic biopsy for liver cancer in a community based setting.

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