Contemporary role of liver biopsy in hepatocellular carcinoma.
Contemporary role of liver biopsy in hepatocellular carcinoma.
复制标题
肝活检在肝细胞癌中的当代作用。
DOI：
10.4254/wjh.v10.i7.452
复制
发表时间：
2018-07-27
影响因子：
2.4
通讯作者：
Mocan T
中科院分区：
文献类型：
--
作者：
Sparchez Z;Mocan T
肝硬变患者合并肝局灶性病变的肝细胞癌的正确诊断是当今最重要的问题之一。肝病学界最古老的争论之一可能是是否对所有有肝脏局灶性病变的肝硬变患者进行肝活检(LB)。我们现在面临着一个肿瘤学正在走向个性化医学的时代。根据目前的欧洲肝病研究协会的肝细胞癌指南，LB在肝细胞癌的治疗中只起到很小的作用。然而，目前的建议是五年多前提出的。随着时间的推移，高通量分子技术的发展有助于揭示肝癌发生发展的主要分子机制。已经描述了几种亚型的肝细胞癌，包括分子和组织学特征。重要的是，这些亚型中的一些对预后有影响。在个人化治疗的背景下，将仔细重新考虑LB的角色。在此之前，有必要了解LB术的各种技术、它们的性能、并发症和局限性。风险和利益的平衡决定了我们作为医疗保健提供者所做的许多决定。在这篇综述中，我们不仅讨论了与肝细胞瘤相关的风险，而且还讨论了活体组织检查在各种临床方案中的好处。在不久的将来，银行的角色将被重新考虑。我们有可能回到过去，再次使用活检来诊断肝细胞癌。然后，我们可能会回到未来，试图改善液体活检在各种治疗方式后对肝细胞癌患者的随访中的使用。
A correct diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy (LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities.