TY - JOUR
T1 - Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit.
AU - Childs, A
AU - Zakeri, N
AU - Ma, YT
AU - O'Rourke, J
AU - Ross, P
AU - Hashem, Essam
AU - Hubner, RA
AU - Hockenhull, K
AU - Iwuji, C
AU - Khan, S
AU - Palmer, DH
AU - Connor, J
AU - Swinson, D
AU - Darby, S
AU - braconi, chiara
AU - Roques, T
AU - Yu, D
AU - Luong, TV
AU - Meyer, Tim
PY - 2021/9/15
Y1 - 2021/9/15
N2 - BackgroundAdvanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK.MethodsThis was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form.ResultsEleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding.ConclusionThe diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy.
AB - BackgroundAdvanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK.MethodsThis was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form.ResultsEleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding.ConclusionThe diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy.
UR - https://europepmc.org/articles/PMC8575957
U2 - 10.1038/s41416-021-01535-2
DO - 10.1038/s41416-021-01535-2
M3 - Article
C2 - 34526664
SN - 0007-0920
JO - British Journal of Cancer
JF - British Journal of Cancer
ER -
