Blaise L, Ziol M, Campani C, Ganne-Carrie N, Nahon P, Nkontchou G, Zucman-Rossi J, Del Pozo L, Barget N, Boros C, Desjonqueres E, Demory A, Grando V, Pescatori L, Seror O, Sutter O, Nault JC.
JHEP Rep. 2025 Apr 22;7(9):101430.
Background & aims: We aimed to assess the safety and diagnostic/prognostic value of tumor and non-tumor biopsies systematically collected during radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).
Methods: We prospectively included patients with a first diagnosis of HCC who underwent tumor and non-tumor biopsies during percutaneous RFA between 2015 and 2021. We analyzed the complications, percentage of diagnostic tumor biopsies, ability to perform molecular biology, and the non-tumor liver biopsy results, and correlated histology with prior non-invasive diagnosis and oncological outcomes.
Results: In total, 248 patients (86% male, median age 68) with 302 tumors treated by RFA and with available tumor biopsy were included. HCC was single in 78% and bifocal in 21% of patients, with a median size of 24 mm. Bleeding occurred in six cases (1.9%) without related deaths. Biopsies enabled HCC diagnosis in 66% of cases, with positivity linked to nodule size (p <0.0001), location (p = 0.04), and ultrasound visibility (p = 0.004). A discrepancy between prior tumor board and subsequent histological diagnosis was observed in 5% of cases. Among the 302 biopsies, 34% were non-diagnostic, 61% were HCC, 3% were cholangiocarcinoma (CCA)/hepatocholangiocarcinoma (cHCC-CCA), and 2% were dysplastic nodules. Survival was shorter in patients with CCA/cHCC-CCA (p <0.001). Macrotrabecular-massive HCC was associated with higher rates of global tumor recurrence (p = 0.037). More than 25% of tumor cells in paraffin-embedded samples were associated with expression of cancer genes on transcriptomic analysis of the corresponding frozen samples, assuring their usefulness for molecular analysis. In non-tumor biopsies, cirrhosis was histologically confirmed in 82% of cases, with a 15% discrepancy between diagnosis of cirrhosis at tumor board and on biopsy.
Conclusion: Systematic tumor and non-tumor biopsy during RFA for a first diagnosis of HCC is feasible, safe, and brings valuable diagnostic, therapeutic, and prognostic data.
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