US-Guided Fine Needle Biopsy of Focal Liver Lesions and Hepatocellular Carcinoma

Percutaneous ultrasonically-guided fine-needle biopsy represents a highly diagnostic procedure for hepatic tumors. Also in small hepatic lesions the puncture may be performed with high accuracy. In the reported series sensitivity of US-guided FNB varies from 83% to 95% [1]. Ultrasonically-guided fine-needle biopsy is a safe and accurate procedure for the diagnosis of hepatocellular carcinoma [2]. In the published series sensitivity was always more than 92% with 100% specificity for absence of false positive. Sometimes US-guided FNB may be diagnostic also for benign hepatic lesions such as regenerative nodules in cirrhosis, cavernous hemangiomas, focal fatty liver. Occasionally, when hemangiomas are biopsied some endothelial cells are detected in the cytologic smears, permitting a specific diagnosis. Recently Cronan et al. [3] performed a biopsy with a 20-gauge Franseen needle in 15 patients with cavernous hemangioma without complications: in all cases the histologic sample was diagnostic. On the other hand, in a recent literature review Smith [4] reported two cases of death following FNB of liver hemangioma. Therefore, the reported cases are, so far, too few to recommend percutaneous biopsy as a safe diagnostic method for hemangioma. In our experience hemangiomas were submitted to FNB for their atypical US pattern or for suspicion of malignancy.