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Liver biopsy for diagnosis of presumed benign hepatocellular lesions lacking magnetic resonance imaging diagnostic features of focal nodular hyperplasia
Author(s) -
Sannier Aurélie,
Cazejust Julien,
Lequoy Marie,
Cervera Pascale,
Scatton Olivier,
Rosmorduc Olivier,
Wendum Dominique
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13113
Subject(s) - focal nodular hyperplasia , medicine , hepatocellular adenoma , biopsy , hepatocellular carcinoma , magnetic resonance imaging , radiology , liver biopsy , pathology , adenoma
Background & Aims The contribution of liver biopsy for the diagnosis of presumed benign hepatocellular lesions lacking the diagnostic features of focal nodular hyperplasia ( FNH ) on magnetic resonance imaging ( MRI ) is unknown. We evaluated liver biopsy and MRI performances in this setting. Methods Magnetic resonance imaging and slides of liver biopsies performed for a presumed benign hepatocellular lesion (2006–2013) without the typical features of FNH on MRI were blindly reviewed ( n = 45). Eighteen lesions were surgically removed and also analyzed. The final diagnosis was the diagnosis established after surgery or on the biopsy in the absence of surgery. Results The final diagnosis was FNH ( n = 19), hepatocellular adenoma ( HCA , n = 15), hepatocellular carcinoma ( n = 3) and indefinite ( n = 4). Four lesions corresponded to non hepatocellular lesions. FNH , HNF 1A mutated and inflammatory HCA were diagnosed accurately on the biopsy in 95%, 67% and 100% of the cases respectively. Diagnostic performance of liver biopsy for HNF 1A mutated HCA was lower because of the lack of non‐tumoral tissue. Diagnosis based on morphological analysis was certain and correct in 27 cases. Immunostaining allowed a definite diagnosis in 12 additionnal cases. Radiological diagnosis was in agreement with the histological diagnosis in 75.6% of the cases, with a very high sensitivity (97%) and specificity (100%) for the diagnosis of HNF 1A mutated HCA . Conclusions Liver biopsy has a good diagnostic performance particularly for FNH and inflammatory HCA , and sampling of non‐lesional tissue is highly recommended. A biopsy does not seem necessary if H‐ HCA is diagnosed on MRI .