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Indication and contraindication for hepatic resection for liver tumors without fine‐needle biopsy: Validation and extension of an Eastern approach in a Western community hospital
Author(s) -
Torzilli Guido,
Olivari Natale,
Del Fabbro Daniele,
Leoni Piera,
Gendarini Adele,
Palmisano Angela,
Montorsi Marco,
Makuuchi Masatoshi
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20051
Subject(s) - medicine , contraindication , medical diagnosis , biopsy , radiology , surgery , spiral computed tomography , liver biopsy , work up , computed tomography , alternative medicine , pathology
Fine‐needle biopsy (FNB) is associated with problems, such as tumor seeding, which are not negligible. The aim of this study was to validate prospectively the accuracy of our diagnostic work‐up without FNB, not just to address but also to rule out from a surgical program patients with focal liver lesions (FLLs). From September 2001 to July 2003, 89 patients were seen at an outpatient clinic for FLLs. Nine patients were excluded because of previous FNB and 18 were excluded because carrier of advanced disease. Sixty‐two patients with 101 FLLs were included. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography (US), and spiral computed tomography (CT). Other imaging modalities were carried out when it was considered necessary. Forty‐eight patients underwent surgery, with histological confirmation of the preoperative diagnosis. The remaining 14 patients underwent a close follow‐up. The preoperative diagnoses of 47 of the 48 patients who underwent surgery were confirmed (97.9%). All of the 14 patients ruled out for surgical treatment did not show FLL progression at 6–24 months of follow‐up. Of the 9 patients who had FNB previously in other centers, 2 had a wrong histological diagnosis. In view of these results, a diagnostic work‐up without FNB seems adequate either to include or to exclude patients with potentially resectable FLL from the surgical program and once more highlight the fact that the use of FNB should be drastically limited. (Liver Transpl 2004;10:S30–S33.)