Q J Med 1995; 88: 819-825
© 1995 Association of Physicians
Liver biopsy in the diagnosis of malignancy
Department of Pathology, Queen's Medical Centre Nottingham 1 Department of Castroenterology, Royal Liverpool University Hospital Liverpool 2 Clinical Operational Research Unit, University College London, UK
Address correspondence to Dr D. Jenkins, Department of Pathology, Queen's Medical Centre, Nottingham NG7 2UH
Received 13 June 1995 Accepted for publication 20 March 1995.
 |
Abstract |
|---|
In a National Audit of 1500 liver biopsies, 38% were for suspected malignancy. To measure their contribution to clinical decisions, the initial diagnoses, biopsy diagnoses, final diagnoses, and outcomes were coded by computer and compared. Most patients (92%) wereinvestigated for advanced malignancy. The accuracy of clinical diagnosis was 78% against final diagnosis. Liver biopsy was seen as ‘confirming’ clinical diagnosis overall. This was achieved in 67% (75%with ultrasound guidance),and specificity was almost 100%. However, hepatocellular cancer was confirmed by biopsy in only 32% and haematological malignancy in 13% of suspected cases. Within 3 months, 44% of patients withhistological malignancy had died. Histological tumour type was not used in 36% of finaldiagnoses. Of patients with a malignancy-negative liver biopsy—showing reactive hepatitis, normality, or cholangitis/cholestasis—25%, 47% and 60%, respectively, had final malignant diagnoses. In 6% of patients, biopsy showed chronic liver disease. Only 12% of deaths were autopsied. Liver biopsy contributes very high specificity to the diagnosis of malignancy, and detects non-malignant disease. Failure to use tumour type may result in sub-optimal therapy. Improving diagnostic practice requires more information on outcomes, including autopsies.