Introduction: Although radiological imaging can often diagnose hepatocellular carcinoma (HCC) in cirrhotic livers, microscopic and molecular analyses offer valuable prognostic and therapeutic insights. Understanding the immunohistochemical and molecular characteristics of HCC biopsy materials can inform prognosis and targeted therapies, making liver biopsy an essential aspect of HCC management. While generally safe, percutaneous biopsies carry potential risks, including tumor seeding, bleeding, and inadequate tissue samples. Studies report a concerning seeding rate of 2.2% following HCC biopsies. This study aims to evaluate the effectiveness of tract cauterization in minimizing these bleeding and seeding complications.
Materials and Methods: This study enrolled 94 patients (67 men and 27 women) diagnosed with cirrhosis and a suspicious liver mass suggestive of HCC between June 2017 and March 2024. All procedures were performed under ultrasound guidance. The masses ranged from 1.5 cm to 15 cm in diameter. A special biopsy needle system was employed. It consisted of a 17-gauge guiding needle with a partial plastic sheath and an 18-gauge core biopsy needle used within the guiding needle. First, a parenchymal liver sample was obtained using the core needle within the guiding needle. Then, the guiding needle was repositioned within the liver to target the suspicious mass, and multiple core biopsies were taken from the mass. To minimize bleeding and tumor spread, an electrocautery device set at 40 watts was used to seal the needle track upon removal of the guiding needle.
Results: The median follow-up period was 27 months (ranging from 2 to 51 months). Technical success was achieved in 100% of all biopsies, with no instances of bleeding or tumoral seeding observed. Among the patients, biopsy results were hepatocellular carcinoma (HCC) in 69 cases, cholangiocarcinoma in 9 cases, metastasis in 3 cases, hemangioma in 1 case, and angiosarcoma in 1 case. Additionally, 7 cases were found to be non-neoplastic, while 2 cases each were diagnosed with lymphoma and neuroendocrine tumors.
Conclusion: Coaxial biopsy with needle tract cauterization offers a promising approach for diagnosing HCC, minimizing risks like bleeding, and the spread of cancer cells.