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We read with interest the recent work by Ho et al demonstrating mutational hyperactivation of mammalian target of rapamycin signalling in a subgroup of hepatocellular carcinoma (HCC).1 As Berasain and Lechel concluded that the prospect of a positive therapeutic response may outweigh the risk associated with the HCC biopsy procedure2 and histology is essential for confirming a diagnosis of intrahepatic cholangiocarcinoma (ICC),3 we revisited the performance of non-invasive HCC diagnosis as recommended by current guidelines (eg, American Association for the Study of Liver Diseases (AASLD)) in clinical practice.4
We retrospectively analysed all patients (n=182) in which a CT-guided liver biopsy was performed at a tertiary referral centre within a 9-year period due to the clinical differential diagnosis of HCC. After quality control, a total of 94 biopsies (figure 1A, see online supplementary table 1) could be evaluated. HCC development was associated with the presence of cirrhosis (n=51/65, p<0.001), which was also found in 27% (3/11) of ICC and 33% (1/3) of combined hepatocellular–cholangiocarcinoma (HCC–CC) patients. The number of false-positive non-invasive HCC diagnosis was higher in patients without cirrhosis (n=13/19; table …
Contributors CM acquired and analysed data, drafted the manuscript. NW acquired data. US interpreted data. HUK and PS critically revised the manuscript. CMS helped in conception of the study, interpreted data and revised the manuscript. TL designed and conceptualised the study, acquired and interpreted data, helped in drafting and revised the manuscript.
Funding TL was supported by grants of the Deutsche Forschungsgemeinschaft (LO-1676/2-1) and the Deutsche Krebshilfe (110881).
Competing interests None declared.
Ethics approval Ethics Committee University Hospital Heidelberg (no. S-621/2013).
Provenance and peer review Not commissioned; internally peer reviewed.
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