Do I Need a Liver Biopsy?
When you have been diagnosed with a liver mass, it is not infrequent that your doctor, or radiologist, will recommend that you have a biopsy of this mass.
There are many ways in which a biopsy can be performed. Sometimes there are indications for this, and there are also compelling reasons why this should not be done. In this section, the idea of liver biopsy, techniques that are possible, and benefits and consequences of this procedure will be discussed.
As imaging techniques and modalities have improved, there have been a large number of tumors of the liver that have been detected that previously would have gone unnoticed. Ultrasound frequently identifies the presence of a "lesion" or abnormality in the contour of the liver. This is followed by more in depth analysis of the liver, most frequently a computed tomography (CT), or magnetic resonance imaging (MRI) of the liver. These particular techniques each have certain features that help identify and help characterize lesions even more. There are many characteristics of these lesions, and these are covered in more detail in that section.
When lesions are identified, there are several immediate considerations. Is this lesion a cystic lesion (does it have fluid in it -- "a fluid filled sac"), is this lesion predominantly one which is a tuft of blood vessels (hemangioma), or is it a solid lesion.
The first two lesions in this category are benign, and when characteristic findings suggest these, no further investigation is necessary. Most of the time, when imaging studies have identified a "solid type" lesion, the next consideration is the utility of the biopsy. There are several biopsies, which can be performed. These biopsies are usually image-guided biopsies: by this, it is meant that lesions are biopsied under the direct guidance of ultrasound, or CT scan, or rarely, MRI. This is done to ensure that the tip of the needle or biopsy device is clearly within the main substance of the tumor.
Even with X-ray guided biopsy, there may be so called "marble cake" effect. This is a descriptive term used when discussing this with patients. By this, the following analogy: you have just returned home, and your roommate has baked a cake, which is a chocolate-vanilla marble cake, but only he or she knows this. The cake has icing on it. You inquisitively ask what kind of cake is this, but your roommate refuses to answer the question straight; rather he or she suggests that you tell him or her the kind of cake it is without cutting it. At this point, you take a straw and pass it through the cake. You examine the core of the cake obtained in the straw. It is entirely possible that you have passed the straw in a portion that only has vanilla, and that you have missed the marble chocolate swirl. Erroneously in that situation, you'll conclude that this is a vanilla cake.
Similarly, with biopsy of tumors this is also possible. In those cases where areas of the mass are biopsied where contains no active tumor, the conclusion of a benign lesion will be made. So the question arises -- was this a representative biopsy, or did we miss the main portion? Ensuing biopsies may be performed.
Even with that, questions will still remain as to the malignant potential of this lesion. Thus in most cases, if the biopsy were clearly malignant an operation would be recommended; when the biopsy unclear, an operation will be still recommended to 'rule-out' the possibility of a malignancy. Given this scenario, in most patients who are healthy, biopsy of solitary liver lesions rarely effects the overall management. In most cases, a solitary liver lesion in a healthy person should undergo resection, unless clear features identify it as a benign lesion which both the physician and the patient are happy to follow on a clinical basis.
