From the Research
Hepatocellular adenomas, particularly those larger than 5 cm, and hypervascular tumors such as hepatocellular carcinoma (HCC) are generally considered inappropriate for biopsy due to their high risk of bleeding or rupture. According to the most recent study 1, hepatocellular adenomas are associated with variable prognoses and have a risk of bleeding and malignant transformation, which depends on tumor size, subtype, and clinical factors. Other hypervascular lesions to avoid biopsying include angiosarcomas and some adenomas, particularly if they are large or superficially located. The risk of bleeding is further increased in patients with underlying coagulopathy, which is common in those with advanced liver disease.
Some key points to consider when evaluating liver tumors for biopsy include:
- The type of liver tumor, with hepatocellular adenomas and hypervascular tumors being high-risk for bleeding or rupture
- The size of the tumor, with larger tumors being more likely to bleed or rupture
- The presence of underlying coagulopathy, which can increase the risk of bleeding
- The use of alternative diagnostic approaches, such as characteristic imaging findings on contrast-enhanced CT or MRI, which can help avoid the need for biopsy
In cases where a tissue diagnosis is absolutely necessary despite these risks, approaches such as transarterial embolization prior to biopsy or using a fine needle with real-time ultrasound guidance may help reduce, but not eliminate, the bleeding risk 2. However, the most recent study 1 recommends elective surgical resection for hepatocellular adenomas that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs, highlighting the importance of careful evaluation and management of these high-risk tumors.