The Bottom Line: This review found that In 41 papers that specified the total number of patients biopsied and/or treated, the median risk of seeding was 2.29% for the biopsy group; 1.4% for percutaneous ethanol injection when used with biopsy and 0.61% for radiofrequency ablation without biopsy, 0.95% for radiofrequency ablation with biopsy and 0.72% for liver nodules biopsied and ablated. The conclusion is that the risk of seeding with hepatocellular carcinoma is substantial and appears greater with using diagnostic biopsy alone. This risk is particularly relevant for patients being considered for liver transplantation.
Stigliano, R Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer treatment reviews yr:2007 vol:33 iss:5 pg:437 -447
Tumor biopsy is generally mandatory for patient management by oncologists. Currently percutaneous ablation is used for cirrhotic patients with small hepatocellular carcinoma, not suitable for resection or waiting for liver transplantation. However, malignant seeding is a recognized complication of both diagnostic and therapeutic procedures. Although percutaneous therapy whether with or without biopsy of a suspected HCC nodule may minimize the risk of seeding, this has not been confirmed.
Table 1. Summary of series documenting seeding of HCC following biopsy or percutaneous therapeutic techniques in which the cohort size is specified Page 439
Table 2. Individual reports of seeding after percutaneous biopsy alone in series of HCC patients in which the size of the cohort biopsied is reported page 440