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Section 5. Medical sciences
Donscaia Anna, Antoch Lilian, Cernat Mircea, Duda Boris,
MSPI Oncology Institute, Republic of Moldova
Samohvalov Serghei, Danich Alexandr, SUMPh "N. Testemitanu" Republic of Moldova E-mail: [email protected]
PERCUTANEOUS LIVER BIOPSY GUIDED WITH ULTRASONOGRAPHY FOR DIFFERENTIAL DIAGNOSIS OF LIVER TUMOR LESIONS
Abstract. Widespread diffusion of ultrasound in medical practice has improved percutaneous biopsy technique for liver tumor lesions diagnosis. The aim of our study was to estimate the efficiency of percutaneous liver biopsy guided with ultrasonography in differential diagnosis of focal liver lesions suspected for tumor ones. The study has been performed between 2015-2017. This study includes data on 156 patients with focal liver lesions suspected for tumor lesion. The patient's age varied from 51 to 69 years. The procedure has been performed with 18G needles with automatic gun PRO-MAG® in out-patients and in-patient conditions. In 147 cases (94.1%) histopathological reports were obtained after percutaneous liver biopsy guided with ultrasonography. In 10 cases (7.0%) the routine pathological examination was supplemented with immunohistochemistry for accurate diagnosis. As a conclusion, the authors consider that the percutaneous liver biopsy guided with ultrasonography is safe and a highly effective diagnostic method for histopathologic confirmation of the diagnosis in patients with liver tumor lesions.
Keywords: tumor liver lesions, percutaneous liver biopsy, histopathology diagnosis confirmation.
Widespread diffusion of ultrasound in medical practice has improved percutaneous biopsy technique for liver tumor lesions diagnosis. The aim of our study was to estimate the efficiency of percutaneous liver biopsy guided with ultrasonography in differential diagnosis of focal liver lesions suspected for tumor ones. The study has been performed between 20152017. This study includes data on 156 patients with focal liver lesions suspected for tumor lesion. The patient's age varied from 51 to 69 years. The procedure has been performed with 18G needles with automatic gun PRO-MAG® in out-patients and in-patient conditions. In 147 cases (94.1%) histopathological reports were obtained after percutaneous liver biopsy guided with ultrasonography. In 10 cases (7.0%) the routine pathological examination was supplemented with immunohistochemistry for accurate diagnosis. As a conclusion, the authors consider that the percutaneous liver biopsy guided with ultrasonography is safe and a highly effective diagnostic
method for histopathologic confirmation of the diagnosis in patients with liver tumor lesions.
Background. Liver biopsy remains the standart procedure in the evaluation of the origin and extend of liver's diseases. In the late 1950s Menghini developed a one second aspiration liver biopsy technique and since that time the procedure has been widely used [7].
The introduction and widespread diffusion of ultrasound in medical practice has improved percutaneous biopsy technique [11].
Liver biopsy is generally safe and it is a powerful clinical tool for liver diseases diagnosis, especially in case of suspected hepatic neoplasm.
The procedure is undertaken on an outpatient basis [1]. The ultrasound guided liver biopsies yielded higher-quality specimens that other methods and allow to obtain the tissues not only for classic histopathological examination, but also for
PERCUTANEOUS LIVER BIOPSY GUIDED WITH ULTRASONOGRAPHY FOR DIFFERENTIAL DIAGNOSIS OF LIVER TUMOR LESIONS
immunohistochemistry method. The immunohistochemistry method could differentiate liver tumor lesions and give possibilities to establish an accurate diagnosis and elaborate an adequate treatment [8; 13].
The most common reason for liver biopsy is focal liver lesions. Hepatocellular carcinoma is a primary malignancy of the liver that needs histopathological confirmation [3; 6; 8]. About 90% of liver biopsies are perfomed for liver metastases [12; 13]. Tomographic characteristics of metastatic liver lesions are nonspecific and biopsy specimens are required for diagnostic establishing [9; 10].
Focal nodular hyperplasia is the second most common lesion of the liver, surpassed in prevalence only by hepatic hemangioma [9; 10].
In medical literature a variety of approaches for obtaining liver tissue specimens have been discussed. Authors [2; 4; 8] conclude that real-time ultrasound guidance is convincing and clinically beneficial, but the procedure have to be performed by specialists, experienced in percutaneous liver biopsies guided with ultrasonography.
The method's sensitivity according to the literature data is about 80% with specificity about 90% [12].
Contraindications for percutaneous liver biopsy are few. Suspection of hemangioma or echinococcal cyst, ascities, thrombocytopenia and hypoprothrombinemia are considered contraindications for this procedure.
Study's aim. The aim of our study was to estimate the efficiency ofthe percutaneous liver biopsy guided with ultrasonography in differential diagnosis of suspected focal liver lesions.
Materials and methods. The study has been performed between 2015-2017. This study includes data on 156 patients with focal liver lesions suspected for tumors. There were 116 male and 40 women included in the study (F: M=1:2.9). The age of the patients varied from 51 to 69 years.
The focal lesions have been revealed beforehand by ultrasonography, computed tomography or MRI. The patients have been examined endoscopicaly (esophagogastroduode-noscopy, colonoscopy) for excluding primary affectations of other organs. In 54 cases (35%) beforehand investigations presented solitary focal liver lesion and in the rest of the cases multiple liver lesions have been determined.
The percutaneous liver biopsy guided with ultrasonography has been performed with 18G needle with automatic gun PRO-MAG®. In out-patients condition the procedure was performed on 115 patients (73.7%) and in 41 cases the procedure has been done on hospitalized patients (26.3%). In the majority of cases the S6 segment of the liver was involved (75%).
According to undertaking examinations the primary liver lesions have been suspected in 97 cases (62.2%) and metastatic lesions - in 59 (37.8%).
Results and discussion. The percutaneous liver biopsy guided with ultrasonography was successful in 147 cases (94.1%), allowing histopathologic confirmation of tumor lesions. In 9 cases (5.9%) the percutaneous liver biopsy guided with ultrasonography did not confirm the tumor lesion.
From 147 patients with histopathological confirmation of liver tumor lesions in 10 cases (7.0%) additional immunohistochemistry method was required to stablish a correct diagnosis. Immunohistochemistry allowed us to set the diagnostic of non-Hodjkin lymphoma with primary liver lesion in 5 cases, (the lesions being positive to CD-20), 4 cases were - metastasis of clear cell renal adenocarcinoma and one case - liver adenomas.
The rest of patients with histopathological confirmation of tumor liver lesions have demonstrated hepatocellular carcinoma in 65 cases (44.2%), adenocarcinoma in 48 cases (32.6%), cholangiocarcinoma - in 6 cases (4.1%) and metastatic lung microcellular carcinoma in 6 cases (4.1%).
Preoperative sedation was used in all patients who undergone percutaneous liver biopsy guided with ultrasonography. The procedure has been performed under local anesthesia.
The complications of percutaneous liver biopsy guided with ultrasonography in our study have been registered in 17.3% of patients. Transient pain was recorded in 26 patients (16.7%) and in one case subcapsular hematoma has been observed (0.6%). The patient was under observation and ultrasonographic monitoring during 5 post-procedural days and had no necessity of active intervention.
The obtained results of the study permitted us to conclude that:
1. The percutaneous liver biopsy guided with ultraso-nography is safe and a highly effective diagnostic method for histopathologic confirmation of the diagnosis in patients with liver tumor lesions. According to our study's data it was possible to confirm diagnosis in 94.1% of cases.
2. The immunohistochemistry method is the main tool for differential diagnosis of metastatic tumors with unknown primary origin or in cases of rare tumor affection.
3. The correct diagnosis in patients with suspected tumoral liver lesions is of great importance for elaborating adequate further treatment.
4. The risk of complications in the percutaneous liver biopsy guided with ultrasonography is minimal: in our study only in one case has been registered a subcapsular liver hematoma without necessity of active intervention.
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