Christophe Aube MD, PhD, Abstract Co-Author: Speaker, Bayer AG Support, General Electric Company

Frederic Oberti MD, Abstract Co-Author: Nothing to Disclose

Benoit Paul Gallix MD, Abstract Co-Author: Nothing to Disclose

Olivier Seror, Abstract Co-Author: Nothing to Disclose

Aurore Caumont-Prim MSc, Abstract Co-Author: Nothing to Disclose

Valerie Vilgrain MD, Presenter: Nothing to Disclose

When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Clinical Practice Guidelines are not seen on imaging, biopsy of nodule larger than 1cm is recommended. The goal of our study was to determine the usefulness of a second biopsy when the first one is inconclusive.

In a multicenter prospective study of 430 cirrhotic patients with nodules < 3 cm detected during surveillance, 152 patients (mean age = 61.95 +/- 8.86 years) with 165 nodules had a percutaneous biopsy of a nodule and adjacent liver using 18G-cutting needles. When the first biopsy was inconclusive (no pathologic diagnosis of nodules), a second biopsy was proposed.

The mean diameter of the nodules was 19.4 +/- 5.7 mm. At first biopsy, the diagnosis was HCC, dysplastic nodule and regenerative nodule in 105 (63.6%), 6 (3.6%) and 10 (6.1%), respectively. No lesion was found at pathology in 43 (26.1%) nodules. 17 (39.5%) of the nodules underwent a second biopsy after a first negative one. The mean diameter of nodules was 18.3 +/- 4.4 mm. At second biopsy, the diagnosis was HCC and dysplastic nodule in 12 (70.6%), and 2 (11.8%), respectively.

When a first biopsy of a small nodule developed on cirrhosis is inconclusive, a second biopsy is useful and rules in a diagnosis of HCC in more than 70% of HCCs that have been missed at the first biopsy.

When a biopsy is required to confirm the diagnosis of a small HCC in cirrhotic patients, a second biopsy should be performed when the first one is inconclusive.

Aube, C, Oberti, F, Gallix, B, Seror, O, Caumont-Prim, A, Vilgrain, V, Usefulness of a Second Biopsy after a First Inconclusive One for the Diagnosis of Small Hepatocellular Carcinoma in Cirrhotic Patients.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13026852.html