Clinicopathological Perspectives of Liver Mass Biopsies: A Single Center Experience of 406 Cases.

Abstract

Background: The increasing use of imaging techniques has led to a rise in the detection of liver masses, making it crucial to accurately diagnose their nature. While advances in radiology have reduced the need for liver biopsy in hepatocellular carcinoma (HCC), biopsy remains essential fo r diagnosing various liver lesions, including metastatic tumors. This study aims to evaluate the diagnostic role of liver core needle biopsies, with a particular focus on identifying the primary tumor in cases of liver metastases with an unknown primary.

Methods: We reviewed a total of 406 liver core needle biopsies performed for liver masses between 2017 and 2022. Clinical, radiological, histopathological and immunohistochemical (IHC) data for primary and metastatic tumors were evaluated.

Results: Of the 406 liver biopsy cases, a significant portion were diagnosed as metastatic lesions, with common primary sites identified as gastrointestinal (GI), lung, and breast cancers. IHC markers showed varying positivity rates across different tumor types, with GATA-3, CDX2, and TTF1 proving particularly useful in distinguishing the tumor origin. While some markers were highly specific, others exhibited variable expression, highlighting the complexity of diagnosing metastatic tumors with unknown primaries.

Conclusion: Liver biopsy remains a crucial diagnostic tool in identification of primary and metastatic liver tumors, especially when the primary site is unknown. IHC analysis enhances the accuracy of diagnosis, though it should be used in conjunction with clinical and radiological data. This study underscores the importance of a multidisciplinary approach in managing liver masses, with further research needed to optimize diagnostic strategies and improve patient outcomes.