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Non-invasive diagnosis of hepatocellular carcinoma revisited
  1. Cora Mueller1,2,
  2. Nina Waldburger1,3,
  3. Ulrike Stampfl2,3,
  4. Hans-Ulrich Kauczor2,3,
  5. Peter Schirmacher1,3,
  6. Christof Matthias Sommer2,3,
  7. Thomas Longerich1,3
  1. 1Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
  2. 2Department of Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
  3. 3Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
  1. Correspondence to Professor Thomas Longerich, Department of Pathology, University Hospital HeidelbergIm, Im Neuenheimer Feld, 224, 69120 Heidelberg, Germany; thomas.longerich{at}

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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 …

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